Term
| Decreases in oncotic pressure (from hypoproteinemia) can result in what two clinical signs? |
|
Definition
|
|
Term
| ______ accounts for about 75% of oncotic pressure. |
|
Definition
|
|
Term
| What is the doctor word for decreased oncotic pressure? |
|
Definition
|
|
Term
| Definition: Dysproteinemia |
|
Definition
| -abnormal concentrations of a normal blood protein |
|
|
Term
| Definition: Total protein |
|
Definition
| -the concentration of all the different proteins in the blood |
|
|
Term
| Where is albumin produced? |
|
Definition
|
|
Term
| What are the functions of albumin? |
|
Definition
| -maintenance of oncotic pressure and serving as a carrier molecule for many other substances that would normally be insoluble in the blood |
|
|
Term
| What is an example an analyte in the blood that depends on albumin concentraion? |
|
Definition
|
|
Term
| What are immunoglobulins? |
|
Definition
| -produced by B-lymphocytes as part of an immune response to antigenic stimulation |
|
|
Term
| What are delayed response proteins/chronic phase proteins? |
|
Definition
-another name for immunoglobulins
-b/c it takes several days to weeks to be produced in enough quantity to increase total globulin concentration |
|
|
Term
| Where are acute phase proteins produced? Why are they called that? |
|
Definition
-liver
-concentration rapidy changes (1-2d) in response to acute inflammation |
|
|
Term
| What is a negative acute phase protein? Example? |
|
Definition
-concentration actually decreases in response to inflammation
-ex: Albumin |
|
|
Term
| What produces fibrinogen? What is it? |
|
Definition
-produced by the liver
-precursor to fibrin |
|
|
Term
| When do you see a decrease in fibrinogen? What about an increase? |
|
Definition
-decrease in bleeding disorders
-increases in inflammation b/c it is an acute phase protein |
|
|
Term
| How do we measure globulins? |
|
Definition
-INDIRECTLY
Total Protein - Albumin = Globulins |
|
|
Term
| How is total protein measured? |
|
Definition
-refractometer
-it is just an estimate and is usually higher than the total protein from the chem profile |
|
|
Term
| The fibrinogen included in a CBC is done via what method? |
|
Definition
| -heat precipitation method |
|
|
Term
| If you want to detect a decrease in fibrinogen, what method do you use? |
|
Definition
|
|
Term
|
Definition
-Serum Protein Electrophoresis
-process by which the various proteins in serum are separated as they migrate through a gel in response to an electric current and separate based on their net negative charge |
|
|
Term
| How will hydration status affect albumin levels? |
|
Definition
-dehydration = inc [albumin]
-overhydration = dec [albumin] |
|
|
Term
| How does liver status affect albumin levels? |
|
Definition
| -liver failure of more than 80% causes decreased albumin |
|
|
Term
Describe the affects of the following on serum proteins:
a) Hemorrhage
b) Glomerular loss
c) GI loss
d) Loss through skin lesions
e) high protein effusions |
|
Definition
a) anemia + globulins + albumin lost
b) albumin drops
c) globulins + albumin lost
d) Globuliins + albumin lost
e) globulins + albumin lost |
|
|
Term
| What are acute phase proteins? |
|
Definition
| -proteins whose concentrations increase quickly, within 1-2 days of beginning acute inflammatio |
|
|
Term
| How does liver failure affect [albumin] & [globulin]? |
|
Definition
| -both drop, but the total globulin concentrations is usually not below the reference interval b/c immunoglobulin production from the lymphocytes will not be affected |
|
|
Term
| True or False: Immunoglobulins are an acute phase proteins. |
|
Definition
| -FALSE, immunoglobulin concentrations take longer to increase |
|
|
Term
| On a SPE, what does a small narrow peak usually indicate? |
|
Definition
| -an increase in one specific protein |
|
|
Term
| The majority of alpha an dbeta globulins are serum proteins made in the ______. Gamma globulins are almost all ______. |
|
Definition
|
|
Term
| Immunoglobulins are found in the gamma region mostly but they can sometimes extend into the ______ regions. IgA and IgM are sometimes found in this region. |
|
Definition
|
|
Term
| If alpha and beta globulins are increased, what is suggested? What about an increase in gamma globulins? |
|
Definition
-acute inflammation
-chronic inflammation, immunoglovulin producing tumors (lymphosarcoma, plasma cell tumor) |
|
|
Term
| What does a broak peak on SPE suggest? A narrow peak? |
|
Definition
-broad = chronic inflammation
-narrow = immunoglobulin producing tumor |
|
|
Term
| How do fibrinogen levels help differentiate b/n dehydration and inflammation? |
|
Definition
-if >10% TP then inflammation
-if not, probably dehydration |
|
|
Term
| What is the main cause of decreased fibrinogen? |
|
Definition
| -Disseminated intravascular coagulation (DIC) |
|
|
Term
| What are 5 common causes of hypoalbuminecia with hypoglobulinemia (panhypoproteinemia)? |
|
Definition
1) Overhydration: dilution of serum proteins but usually a mild decrease
2) blood loss
3) protein losing enteropathy: inflammatory bowel disease, lymphangiectasia, neoplasia
4) exudative skin lesions
5) high protein effusions |
|
|
Term
| What are a few causes of hypoalbuminemia with normal to increased globulins? |
|
Definition
-Liver failure of at least 80%: decreased production (with icterus, high bilirubin, high liver enzymes)
-Malnutrition: lack of enough AAs (starvation, intestinal malabsoprtion, exocrine pancreatic insufficiency, GI parasitism)
-acute inflammation: negative acute phase protein
-chronic inflammation: often increased globulin
-glomerular disease |
|
|
Term
| Name a common cause or two of hypoglobulinemia with normal to increased albumin. |
|
Definition
-Failure of passive transfer (FPT): globulins in newborn animals come from the colostrum
-inherited or acquired immunodeficiency conditions (radial immunodiffusion) |
|
|
Term
| What is the hallmark of hyperalbuminemia? |
|
Definition
|
|
Term
| What is a common cause or two of hyperalbuminemia with hyperglobulinemia? |
|
Definition
-dehydration if A:G ratio is normal
-if you have high albumin with a low A:G ratio, probably dehydration with inflammation |
|
|
Term
| What are a few common causes of hyperglobulinemia with normal to decreased albumin? |
|
Definition
-acute inflammation (inc in alpha and beta regions on SPE)
-chronic inflammation/immune stimulation (broad inc in gamma globulins in SPE)
-lymphoid neoplasia: single narrow peak in gamma or beta region |
|
|
Term
| What commonly results in a polyclonal response on an ESP? |
|
Definition
| -perisisent canine ehrlichiosis, leishmaniasis, chronic pyoderma, etc |
|
|
Term
|
Definition
| -the physiologic cessation of bleeding |
|
|
Term
| What are the essential factors that are required for coagulation to occur? |
|
Definition
-blood platelets
-coluble coagulation factors |
|
|
Term
| Coagulatio does not normally occur without vascular injury because of what two reasons? |
|
Definition
-coagulation factors are mostly present in an inactive form
-endothelial cells that line all blood vessels passively and actively function to inhibit coagulation |
|
|
Term
| True or False: The endothelial lining of blood vessels is a nonthrombogenic surface and the CT under it is extremely thrombogenic and starts the process of coagulation when exposed by vessel injury. |
|
Definition
|
|
Term
| The initial even in hemostasis is a reflex (constriction/relaxation) of local blood vessels. Why? |
|
Definition
-constriction
-limits blood flow in the affected area to reduce bleeding and slow the flow of platelets and coagulation factors, keeping them from being swept away from the area aftery they are activated |
|
|
Term
| Definition: Platelet adhesion |
|
Definition
| -platelets line up along the injured area during primary hemostasis |
|
|
Term
| Once platelets are activated in primary hemostasis, they Change shape and secrete what? What does this result in |
|
Definition
-platelet agonists
-activation of additional platelets which bind to the original ones in platelet aggregation |
|
|
Term
| What is the eventual result of primary hemostasis? |
|
Definition
| -formation of a platelet plug at the site of injury |
|
|
Term
| Where are soluble coagulation factors produced? |
|
Definition
|
|
Term
| What is the end result of the coagulation cascade? |
|
Definition
| -fibrinogen (Factor I) is converted to fibrin at the site of the platelet plug |
|
|
Term
| What is the purpose of fibrin in secondary hemostasis? |
|
Definition
| -acts like a biological glue to stabilize the platelet plug and permanently stop bleeding |
|
|
Term
| What is absolutely necessary for platelet adhesion to collagen in the subendothelium? |
|
Definition
| -von Willebrand factor (vWf) |
|
|
Term
| What produces von Willebrand factor? |
|
Definition
| -vascular endothelial cells |
|
|
Term
| True or False: Unlike fibrinogen, von Willebrand FActor deficits would lead to defects in primary and secondary hemostasis. |
|
Definition
| -FALSE, the other way around |
|
|
Term
| What is the most common cause of abnormal bleeing seen in veterinary medicine? |
|
Definition
|
|
Term
| What is the receptor for vWf? What about for fibrinogen? |
|
Definition
-glycoprotein Ib
-glycoprotein IIb/IIIa |
|
|
Term
| What is a pharmaceutical cause of abnormality in platelet function? |
|
Definition
| -NSAIDS that block the thromboxane pathway |
|
|
Term
| What are the 5 major things needed for primary hemostasis to occur normally? |
|
Definition
1) normal subendothelium
2) adequate numbers of platelets
3) normal platelet function
4) von Willebrand factor
5) i have no clue, the notes are weird |
|
|
Term
| What are the top differentials for a patient with an issue with primary hemostasis? |
|
Definition
1) thrombocytopenia
2) von Willebrand disease
3) abnormal platelet function |
|
|
Term
| True or False: Physiologically, activation of the intrinsic pathway is by far the most important and the extrinsic mostly acts as an amplification loop. |
|
Definition
| -FALSE, activation of the extrinsic pathway is by far the most important and the intrinsic mostly acts as an amplification loop |
|
|
Term
| What are the parts of the Intrinsic pathway? The Extrinsic? Common? |
|
Definition
-Intrinsic: 12 => 11 => 9 => 8
-Extrinsic: 7
-Common: 10 => 5 => 2 (Trhombin) => 1 (Fibrinogen) |
|
|
Term
| True or False: Coagulation factors are all synthesized by the liver and circulate in the blood as inactive precursors. |
|
Definition
|
|
Term
| Which coagulation factors are the non-enzymatic factors? |
|
Definition
|
|
Term
| What enzyme cleaves Factor I (fibrinogen) to fibrin? Why does it do this? |
|
Definition
-thrombin
-fibrin acts as an adhesive protein that stabilizes the clot and is thus the whole point of the coagulation cascade |
|
|
Term
| Which coagulation factors are Vit K dependent? What is a common clinical presentaiton concerning these factors? |
|
Definition
-Factors II, VII, IX, and X
-consumption of rat poison |
|
|
Term
| True or False: The coagulation factor reactions all take place on a phospholipid surface. |
|
Definition
|
|
Term
| True or False: Spontaneous bleeding is more lilely to be the result of trauma than a coagulation defect. |
|
Definition
| -FALSE, spontaneous bleeding is more likely to be the result of a coagulation defect than trauma induced. |
|
|
Term
| What are the clinical signs strongly associated with a defect in primary hemostasis? |
|
Definition
-petechial hemorrhages (usually with thhrombocytopenia)
-ecchymoses in primary or secondary
-bleeding in mucosal surfaces
-slow, prolonged bleeding from small wounds |
|
|
Term
| What are the signs strongly associated with a defect in secondary hemostasis? |
|
Definition
-large hematoma formation
-hemoabdomen, hemarthrosis, hemothorax (often with vitamin K antagonism
-more of a frank hemorrhage from a single site of trauma |
|
|
Term
| What does a buccal mucosal bleeding time (BMBT) test evaluate? |
|
Definition
-the primary hemostatic system
-measures the amount of time it takes for bleeding to stop from a small standardized stab incision |
|
|
Term
| What is the normal parameters for a dog from a BMBT test? |
|
Definition
|
|
Term
| Abnormal bleeding time can result from any problem in primary hemostasis. What are you main three differentials? |
|
Definition
-inadequate platelet numbers
-inadequate platelet function
-con Willebrand factor deficiency |
|
|
Term
| True or False: A BMBT test is very sensitive. |
|
Definition
|
|
Term
| Why can you not use a scalpel blade to perform a BMBT test? |
|
Definition
| -the incision must be small enough that hte bleeding can be stopped with only the formation of a platelet plug |
|
|
Term
| Where on the body is a BMBT test performed? |
|
Definition
| -inner surface of the lip |
|
|
Term
| Should you run a BMBT test on an animal with thrombocytopenia? Why or why not? |
|
Definition
| -no because low platelet count by itself can prolong hte BMBT |
|
|
Term
| What is the most common of the inherited bleeding disorders? |
|
Definition
|
|
Term
| What breed(s) is especially known for vWf? |
|
Definition
| -Doberman Pinschers (up to 70%), Shelties, German Shorthaired Pointers, and Scottish Terriers |
|
|
Term
| What is the normal range for a dog being tested for vWf? |
|
Definition
->70% is normal
-most animals with vWd are less than 30% |
|
|
Term
| What breed of cattle are knwon for having platelet function defects? |
|
Definition
|
|
Term
| What is the standard test for platelet function? How are platelet function defects usually diagnosed? |
|
Definition
-Aggregometry: tests ability of the platelets to aggregate in response to the addition of various agonsits known to activate platelets
-diagnosed by exclusion |
|
|
Term
| Explain an Activated Clotting Time (ACT) test. |
|
Definition
-an in clinic test that is used as a screening test
-tube contains diatomaceous earth, which activates the intrinsic coagulaiton pathways
-simply put blood in the tube and checking for clotting every 10 seconds |
|
|
Term
| What are the normal parameters for a dog for the ACT? A cat? |
|
Definition
-dog: <90 seconds
-cat < 165 seconds |
|
|
Term
| True or False: Only a deficiency in the intrinsic system will prolong an ACT. |
|
Definition
| -FALSE, a deficiency in the intrinsic or common system will prolong an ACT. |
|
|
Term
| What factors are tested with an ACT? What factors are not? |
|
Definition
-Tested: 12, 11, 9, 8, 19, 5, 2, 1
-Not tested: 7 |
|
|
Term
| How does severe thrombocytopenia affect an ACT? |
|
Definition
| -if <10000 can cause a mild prolongation of the ACT |
|
|
Term
| Which pathway(s) does the activated partial thromoblastin time (PTT) test evaluate? |
|
Definition
|
|
Term
| How does a PTT stack up agains an ACT? |
|
Definition
| -more precise and more sensitive |
|
|
Term
|
Definition
| -serum is put in the blue top tube, a reagent is added to act as the reaction surface, then add calcium and record the time it takes to clot |
|
|
Term
| True or FAlse: Unlike an ACT, a PTT will not be affected by the platelet count. |
|
Definition
|
|
Term
| Which pathway(s) does the one stage prothrombin time (PT) test evaluate? |
|
Definition
| -extrinsic and common pathways |
|
|
Term
| For either the PT or PTT to be prolonged, the concentration of one or more of the coagulation factors tested must be below about __% of normal. |
|
Definition
|
|
Term
| Does it matter how far you fill the citrate tube when running a PT/PTT? |
|
Definition
| -YES, if you fill it too little, there will be relative excess of anticoagulant and you will have an artificial prolongation of the test |
|
|
Term
|
Definition
| -fibrinogen degradation products- the many protein fragments that can be produced when either fibrinogen or fibrin is cleaved by plasmin in the process of fibrinolysis (breakdown of clots) |
|
|
Term
| True or False: D-dimers are a specific subset of FDPs. How are they formed? |
|
Definition
-TRUE
-formed by the breakdown of cross-linked fibrin and not fibrinogen itself |
|
|
Term
| Increased concentrations of FDPs or D-dimers indicate what? |
|
Definition
-that fibrinolysis is occuring at an accelerated rate
-thus thrombotic disease
-mild increase = hemorrhage into body cavities, widespread inflammation, hepatic disease |
|
|
Term
| If yur D-dimers are up to 500-1000 what is suggested? 1000 or greater? |
|
Definition
-trauma, post-surgery, liver disease, etc
-thromboembolism |
|
|
Term
| What is the most common cause of abnormal bleeding? |
|
Definition
|
|
Term
| What are the four major disease processes that lower the platelet count low enough to cause spontaneous bleeding? (<20,000) How do you diagnose them? |
|
Definition
1) Rickettsial disease (ehrlichiosis and anaplasmosis in dogs): petechiae or mucosal hemorrhages, pancytopenia <= diagnose with PCT or SNAO
2) Immune-mediated thrombocytopenia: common in dogs only; can be paraneoplastic or idiopathic <= see reaction to immunosuppresive therapy
3) DIC: widespread coagulation; consumptive coagulopathy <= long PT/PTT/ACT and inc D-dimers with schistocytes and keratocytes
4) Bone marrow disease: thrombocytopenia + pancytopenia + anemia |
|
|
Term
| What are some common triggers of DIC? |
|
Definition
| -sepsis, widespread tissue trauma, heatstroke, neoplasia, and severe systemic inflammatory diseases (pancreatitis, peritonitis, etc) |
|
|
Term
| What is the doctor word for platelet function defects? |
|
Definition
| -thrombopathia or thromopathy |
|
|
Term
| Which animals are known for inherited platelet dysfunction? |
|
Definition
-Dogs: Bassett hounds, Otterhounds, Cocker Spaniels, Spitz, Great Pyrenes
-Cats: Persian
-Simmental cattle |
|
|
Term
| How do acquired platelet function defects come about? |
|
Definition
-NSAIDS
-renal failure, hepatic failure |
|
|
Term
| How will an acquired platelet function deficits look when tested? |
|
Definition
| =normal platelet count, normal vWf levels, with prolonged BMBT |
|
|
Term
| What are the most common inherited defects of secondary hemostasis? |
|
Definition
-deificencies of Factor VIII (hemophilia A), Factor IX (hemophilia B) and Factor XI
-Factor VIII is most common |
|
|
Term
| What dog breed is known for Factor VIII deficiency? |
|
Definition
|
|
Term
| A deficiency of what factor is well reported in cats? |
|
Definition
| -Factor XII but do not show abnormal bleeding episods and have abnormal PTs |
|
|
Term
| What is the most common disease affecting the coagulation proteins (secondary hemostasis)? |
|
Definition
|
|
Term
| What enzyme reduced Vit K? |
|
Definition
| -vitamin K epoxide reductase |
|
|
Term
| What do vitami K antagonists actually do? |
|
Definition
| -they inactivate the Vit K eoxide reductase enzyme, thus cannnot reactivate vit K |
|
|
Term
| Which factor has the shortest half life? |
|
Definition
|
|
Term
| What are the clinical signs and test results for vitamin K antagonism? |
|
Definition
-prolonged PT and PTT
-normal platelet counts
-body cavity hemorrhage, dyspnea due to hemothorax, hematoma formation at sites of venipuncture |
|
|
Term
| Vitamin K deficiency can be seen in animals with a severe case of what disease? |
|
Definition
| -cholestatic liver disease |
|
|
Term
| How do you treat an animal with vitamin K antagonism? |
|
Definition
-give active vitamin K
-respond within 24 hours |
|
|
Term
| Liver failure can cause reduced concentrations of coagulation factors by wht 2 mechanisms? |
|
Definition
-decreased production of coagulation factors
-obstruction of bile flow means to vitamin K is absorbed |
|
|
Term
| Does DIC affect primary or secondary hemostasis? |
|
Definition
|
|
Term
|
Definition
| -thrombocytopenia, prolonged PT and PTT with elevated D-dimers |
|
|
Term
| What three components of the peripheral blood does a CBC evaluate? |
|
Definition
| -erythrocytes, leukocytes, and platelets/thrombocytes |
|
|
Term
| Definition: Packed cell volume (PCV) |
|
Definition
-measured by a CBC
-percentage of whole blood composed of erythrocytes |
|
|
Term
| Definition: Hematocrit (HCT) |
|
Definition
-measure of erythrocyte mass expressed as a percentage
-if the PCV and HCT differ by more than 6% there is usually a problem |
|
|
Term
| What is the formula for hematocrit? |
|
Definition
|
|
Term
| Definition: Red blood cell count (RBC) |
|
Definition
| -number of erythrocytes per microliter of blood |
|
|
Term
| Definition: hemoglobin concentration (Hgb) |
|
Definition
| -amount of hemoglobin present in the blood (normally inside the red cells) directly measured by an automated analyzer |
|
|
Term
| What are some simple causes of falsely elevated Hgb? |
|
Definition
| -things that interfre with light absorbance (lipid droplets or free Heinz bodies) |
|
|
Term
| Hgb concentration should always be about what fractiof of the PCV/HCT? Any exceptions? |
|
Definition
|
|
Term
| Definition: Mean cell volume (MCV) |
|
Definition
-measurement of the average size of the red cells in circulation
-either macrocytic, normocytic, or microcytic |
|
|
Term
| What are a few possible causes of macrocytosis? |
|
Definition
| -regenerative anemia, hereditary macrocytosis of Poodles, FeLV, and common in Greyhounds |
|
|
Term
| What are a few possible causes of microcytosis? |
|
Definition
| -iron deficiency, portosystemic shunt, Asian dog breeds |
|
|
Term
| Definition: Mean cell hemoglobin content (MCHC) |
|
Definition
| -measurement of the average amount of Hgb per volume of red cells |
|
|
Term
| What is the doctor word for a cell population withh an increased MCHC? A normal one? How about a low one? |
|
Definition
-hyperchromic
-normochromic
-hypochromic |
|
|
Term
| How do you interpret an MCHC significantly above the reference interval (>40)? |
|
Definition
|
|
Term
| In what two biological errors will you get a decreased MCHC? |
|
Definition
-young cells released from the bone marrow early in reponse to aimhanemia
-problems with Hgb synthesis (iron deiciency) |
|
|
Term
| Definition: Mean cell hemoglobin (MCH) |
|
Definition
| -measures Hgb content but depends on the RBC count instead of PCV and therefore less accurate |
|
|
Term
| What are some causes for increased numbers of nRBCs? |
|
Definition
-early release from marrow with regenerative anemia, marrow injury
-extramedullary hematopoiesis, splenectomy or spenic dysfunction, lead toxicity, steroid therapy, and erythroid neoplasia |
|
|
Term
|
Definition
| -immature red cells still containing some mitochondria and ribosomes that aggregate into a blue reticulum when stained with vital stains such as new methylene blue |
|
|
Term
| What are polychromatophils? |
|
Definition
| -red cells that stain slighlty blue and are slightly larger than mature red cells |
|
|
Term
| Circulating reticulocytes are an indication of what? |
|
Definition
|
|
Term
| True or False: Reticulocyte counts are more sensitive than polychromasia for detecting a regenerative process. |
|
Definition
|
|
Term
| What is special about horses regarding reticulocytes? |
|
Definition
| -horses typically do not release reticulocytes into peripheral blood (they mature in the marrow instead, even in a regenerative anemia) |
|
|
Term
| What is special about dogs regarding reticulocytes? |
|
Definition
| -dogs have low numbers but can generate large numbers of reticulocytes in response to anemia (>500k) |
|
|
Term
| What are special about bird and reptile red blood cells? |
|
Definition
| -they are nucleated and oval |
|
|
Term
| What are special about camelid red blood cells? |
|
Definition
|
|
Term
| Rank the common spp by size of RBC. |
|
Definition
| dog> cat> cattle/horses> sheep>goats |
|
|
Term
| What does polychromasia suggest? |
|
Definition
|
|
Term
| What does "hypochromasia" mean? |
|
Definition
| -red cells that are too pale due to lack of hemoblogin |
|
|
Term
| What is the most common cause of hypochromasia in dogs and camelids? How does this compare to other species? |
|
Definition
-iron deficiency
-other species' red cells usually don't appear hypochromic with iron deficiency |
|
|
Term
| What does hyperchromasia indicate? |
|
Definition
|
|
Term
|
Definition
| -variation in size noted on the blood film |
|
|
Term
|
Definition
| -red cells that are smaller than normal |
|
|
Term
Definition: Macrocytosis
-What is its most common cause? |
|
Definition
-red cells that are larger than normal
-regenerative anemia |
|
|
Term
| What does macrocytosis without polychromasia indicate? |
|
Definition
-hereditary macrocytosis of poodles, FeLV infection, and heraditary stomatocytosis
-or it is a Greyhound |
|
|
Term
Definition: Poikilocytes
When are they common? |
|
Definition
-general term for abnormally-shaped red cells
-common in young calves and goats, and pigs of any age |
|
|
Term
|
Definition
| -lost their normal biconcave shape and become spheres appearing slightly smaller and denser (darker red) than normal red cells |
|
|
Term
| What disease processes does the presence of spherocytes suggest? |
|
Definition
| -IMHA, Heinz body anemia, zinc toxicosis, after a blood transfusion, and microangiopathic injury |
|
|
Term
|
Definition
| -red cell fragments, resulting from shearing of red cells by intravascular trauma (microangiopathy) |
|
|
Term
| What disease processes does the presence of schistocytes suggest? |
|
Definition
| -DIC, hemangiosarcoma (shistocytes + acanthiocytes), vasculitis, heartworm disease, iron deficiency (schistocytes + keratocytes), glomerulonephritis, liver disease, and heart failure |
|
|
Term
|
Definition
-formed from physical or chemical injury to red cells (which may occur secondary to iron deficiencey, oxidative damage, or microangiopathic disease processes)
-aka blister cells |
|
|
Term
|
Definition
-cells that have a few blunt, irregularly distributed spicules projecting from them
-result form changes in hte lipid ocntent of red cell membranes |
|
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Term
| What disease processes does thee presence of acanthocytes suggest? |
|
Definition
| -liver disease, hepatic lipidosis, microangiopathic disease (especially canine hemangiosarcoma) |
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Term
|
Definition
| -spiculated with numerous short, evenly spaced, uniform projections that are often pointed |
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Term
| What does the presence of echonocytes suggest? |
|
Definition
| -old sample, renal disease, lymphoma, chemotherapy, electrolyte abnormalities, and envenomation |
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Term
|
Definition
-result of oxidative injury and may be seen along with Heinz bodies
-have one edge of their membrane fused together and devoid of Hgb (appear dense on one side and clear on the other) |
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Term
| What does the presence of eccentrocytes suggest? |
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Definition
| -horses with red maple toxicity, lymphoma, hyperthyroidism, and diabetes mellitus |
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Term
| What are codocytes? What does their presence suggest? |
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Definition
-aka target cells (a central area of Hgb separated from the Hgb around the edge of the cell)
-no real diagnostic significance |
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|
Term
|
Definition
-when red cells stack up like a roll of coins
-often seen in normal horses |
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Term
|
Definition
| -red cells adhere to each other in grape-like clusters due to antibody-mediated bridging between cells |
|
|
Term
| What does the presence of agglutination suggest? |
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Definition
| -IMHA, but have to do a saline agglutination test to make sure |
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Term
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Definition
-small circular structure within or portruding from the red cell, and may be the same color as the cell or somewhat paler
-denatured Hgm resulting from oxidative damage
-they alter the RBC cell membrane and make it more susceptible to intravascular hemolysis |
|
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Term
| What type of animal is more prone to Heinz body formation? |
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Definition
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|
Term
| What does the presence of Henzi bodies suggest? |
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Definition
| -Vitamin K antagonism, lymphoma, hyperthryoidism, and diabetes mellitis |
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Term
| What are Howell-Jolly bodies? What do they suggest? |
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Definition
-nuclear remnants appearing as small round basophilic inclusions on a Wright's-stained blood flim
-suggest regenerative anemia or splenic dysfunction |
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|
Term
| What is basophilic stippling? |
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Definition
| -numerous small basophilic dots inside red cells on a Wright's stained blood film and reflets aggregated ribosomes in the cells |
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Term
| What does the presence of basophilic stippling suggest? |
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Definition
-intensely regenerative anemia
-basophilic stippling + nRBCs suggests lead poisoning |
|
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Term
| True or False: Parasites in or on red cells may induce an immune-mediated hemolytic anemia |
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Definition
-TRUE
-ex: Mycoplasma haemofelis, Cytauxzoon felis, |
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Term
| How does M. haemofelis appear on a blood film? Compare it to C. felis. |
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Definition
-on, not in, red cells, and appears as small rod-shaped organisms on the red cell periphery or as ring-shaped structures on the cell
-C. felis is actually within red cells and looks like a signet ring (often non-regenerative) |
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Term
| What are the common erythroparasites of digs? |
|
Definition
-Mycoplasma haemocanis Babesia gibsoni, and Babesia canis
-M. haemocanis is only in splenectomized or immunocompromized |
|
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Term
| How does M. haemocanis appear on a blood smear? |
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Definition
| -small chains of organisms across the suface of the red cell |
|
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Term
| How does B. canis appear on a blood film? |
|
Definition
|
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Term
| What are the major erythroparasites in cattle and goats/sheep? |
|
Definition
-Cattle: Anaplasma marginale as small round basophilic bodies at the periphery of the red cells and Mycoplasma wenyonii
-Sheep/goats: Anaplasma ovies and Mycoplasma ovis |
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Term
| What is the saline agglutination test? |
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Definition
-test to differentiate rouleaux formation fro true agglutination of red cells
-agglutination indicates immune-mediated destruction of red cells
-combine a drop of blood and saline and look, rouleaux will disperse |
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Term
| What is a Coombs' test (direct antiglobulin)? |
|
Definition
-ised when immune-mediated destruction of red cells is suspected, but agglutination is not observed
-detects the presence of antibodies and/or complement bound to red cells, and is more sensitive than agglutination
-positive = IMHA |
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|
Term
Definition: anemia
-associated clinical signs? |
|
Definition
-a decrease in the RBC mass that results in decreased oxygenation of tissues
-clinical signs: pale mucous membranes, lethargy, excercise intolerance, tachypnea, tachycardia, and sometimes collapse |
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|
Term
| What are the three basic mechanisms of anemia? |
|
Definition
1) blood loss (hemorrhage)
2) blood destruction (hemolysis)
3) decreased production (bone marrow suppression) |
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|
Term
| What is the significance of a regenerative anemia? |
|
Definition
| -it tells you that the bone marrow is responding normally, thus probably due to either blood loss or blood destruction |
|
|
Term
| How will a marked regeneration show up in a MCV and MCHC? How will it be described? |
|
Definition
-MCV increased & MCHC will be decreased
-macrocytic, hypochromic anemia |
|
|
Term
| What are the three methods by which to detect regenerative anemia? Which is most accurate? |
|
Definition
-RCC indices
-Polychromasia
-Reticulocyte count: most sensitive |
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|
Term
| ______s usually don't have circulating reticulocytes in the absence of anemia so any reticulocytosis likely reflects a regenerative anemia. ______s do not release reticulocytes into peripheral ceirculation at all. |
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Definition
|
|
Term
| What is the formula for corrected reticulocyte percentage? |
|
Definition
| Corrected reticulocyte % = reticulocyte % X (Patient PCV/Normal PCV) |
|
|
Term
| What are the two types of hemorrhage? |
|
Definition
|
|
Term
| How does a case of acute hemorrhage present? |
|
Definition
-low TP
-clinical evidence of bleeding
-thrombocytopenia to marked thrombocytopenia
-acanthocytes + schistocytes = hemangiosarcoma in dogs (intermittent bleeding)
-schistocytes + thrombocytopenia = DIC |
|
|
Term
| How does a case of chronic hemorrhage present? |
|
Definition
| -clinical evidence of GI hemorrhage, TP low or normal, thrombocytosis, see morpholigic changes typical of iron deficiency: microcytosis, hypochromasia, keratocytes, schistocytes |
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|
Term
| What are some possible causes of hemorrhage? |
|
Definition
| -trauma, coagulation disorders (thrombocytopenia <20,000), neoplasia, inflammatory bowel disease, blood-sucking parasites |
|
|
Term
| Signs of regeneration should be observed within __-__ days and peak within a week. |
|
Definition
|
|
Term
| Hemolysis can be intravascular or extravascular. How can you tell the difference between the two? |
|
Definition
-Extravascular (more common): splenomegaly or hepatomegaly
-Intravascular: hemoglobinemia and hemobglobinuria |
|
|
Term
| True or False: In general, anemias due to hemolysis or bleeding into body cavities tend to ve more strongly regenerative than anemias due to external blood loss |
|
Definition
|
|
Term
| What is the most common cause of hemolytic anemia in dogs? What causes it? |
|
Definition
-IMHA
-results from antibody formed against antigens on red cells or antibody complexes attaching to red cells, removed by extravascular hemolysis but can also cause intravascular hemolysis |
|
|
Term
| What are the test results associated with IMHA? |
|
Definition
- severe anemia, strongly regenerative, inflammatory leukogram, spherocytes or agglutination
-rarely non-regenerative |
|
|
Term
| In adult animals, what is almost always th cause of iron deficiency? What about in neonates? |
|
Definition
-chronic blood loss
-dietary deficiency |
|
|
Term
| What is the hallmark of iron deficiency? |
|
Definition
-decreased MCV due to smaller cells
-appears hypochromic, MCHC decreased, microcytic, hypochromic anemia
-with keratocytes and schistocytes
-thrombocytosis |
|
|
Term
| True or False: Although iron deficiency that is due to chronic blood loss usually starts as a regenerative anemia, it is often poorly regenerative, and may become non-regenerative in later stages |
|
Definition
|
|
Term
| Rank the animal species based on prevelance of iron deficiency. |
|
Definition
| -dogs > ruminants > horses and cats |
|
|
Term
| Hemosiderin can be evaluated in the bone marrow of most species except ______, which normally don't have visible iron stores in the marrow. |
|
Definition
|
|
Term
| What is disseminated intravascular coagulation? |
|
Definition
| -uncontrolled activation of the coagulation and fibrinolytic cascades |
|
|
Term
|
Definition
| -thrombocytopenia, schistocytes, keratocytes |
|
|
Term
| In what two ways can DIC contribute to anemia? |
|
Definition
1) causing bleeding
2) direct trauma/hemolysis of red cells |
|
|
Term
| Definition: Non-regenerative anemia |
|
Definition
| -one in which the bone marrow is not appropriately responding |
|
|
Term
|
Definition
| -decreased numbers of all three cell lines in the peripheral blood |
|
|
Term
| What are he common causes of pancytopenia? |
|
Definition
| -stem cell injuries due to drugs, viruses, immune-mediated disease, and others |
|
|
Term
| How does an anemia of chronic disease present? |
|
Definition
-aka anemia of inflammatory disease
-very common cause of mild, non-regenerative anemia
-normocytic, normochromic |
|
|
Term
| How does an anemia of chronic renal failure present? |
|
Definition
-erythropoietin prodcued by the kidney is essential for stimulation of bone marrow erythropoiesis
-thus anemia is normocytic, normochromic and takes a long time to develop
-also see inc serum BUN, creatine, and production of unconcentrated urine |
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|
Term
| What is a common canine anemia of endocrinopathies? |
|
Definition
-hypothyroidism or hypoadrenocorticism
-mild normocytic, normochronic non-regeneraitve anemia |
|
|
Term
| What are the common causes of aplastic anemia? |
|
Definition
| -toxin, immunosuppressive drugs, estrogen toxicosis, antibiotics, anticonvulsants, some pants, FeLV in cats, EIA in horses, chronic ehrlichiosis in dogs |
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|
Term
| Definition: Myelophthisis |
|
Definition
-normal hematopoietic tissue in the marrow has been replaced by something agnormal: a proliferation of neoplastic cells, stromal, or inflammatory cells
-marked increase the leukocyte count |
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|
Term
Describe the significance of the following:
a) normocytic, normochromic
b) macrocytic, hypochromic
c) macrocytic, normochromic
d) microcytic, hypochromic
e) mircrocytic, normochromic
f) hyperchromic |
|
Definition
a) non-regenerative anemia
c) strongly regenerative anemia
c) regenerative anemia, FeLV
d) iron deficiency or portosystemic shunt
e) iron deficiency or portosystemic shints
f) artifact |
|
|
Term
|
Definition
| -an increase in red cell mass with increase in the PCV + RBC + Hgb |
|
|
Term
| What does relative polycythemia mean? |
|
Definition
-not really an increase in the total number of red cells in the body
-most common
-decrease in plasma volume or erythrocyte redistribution |
|
|
Term
| What causes a decrease in plasma volume? |
|
Definition
-caused by fluid shifts usually secondary to dehydration
-very common with vomiting or diarrhea, secondary to endotoxic shock
-leukocyte and platelet numbers are not increased by dehydration |
|
|
Term
| What causes splenic contraction? In what species is it most common? |
|
Definition
-splenic contraction
-most commonly in ihorses and cats
-TP is not increased an dPCV is elevated transiently |
|
|
Term
| What is absolute polycythemia? |
|
Definition
-there is actually an increase in red cell mass in the body, implying increased production of red cells
-persistent |
|
|
Term
| What is seconary absolute polycythemia? |
|
Definition
-increased red cell production secondary to excess erythropoietin production
-if there is a physiologic reason for epi production ot b increased, this is considered appropriate secondary polycythemia (severe chronic heart failure, high altitude disease, and severe obesity) |
|
|
Term
| What is inappropriate secondary polycythemia? |
|
Definition
| -when epo production can also be increased when there is no physiologic reason present (in these animals the pO2 is normal, but erythropoietin levels are increased) |
|
|
Term
| What is primary absolute polycythemia? |
|
Definition
-a myeloproliferative disorder of red cells with uncontrolled production that results in an increased red cell mass
-red cells mature normally, but proliferate independent of epo concentrations |
|
|
Term
| What are the three major components of a leukogram? |
|
Definition
1) total WBC count
2) differential cell count
3) morphologic evaluation of the leukocytes |
|
|
Term
| What are the leukocytes that are normally seen in the peripheral blood? |
|
Definition
| -neutrophils, lymphocytes, monocytes, eosinophils, and basophils (in order of most common to least ocmmon) |
|
|
Term
| What are the two main ways that automated hematology analyzers measure cell counts? |
|
Definition
-1) Impenace: cell are suspended in an electrolyte solution that is a good conductor of electricity=> passed through a small aperture they impede the electrical current present prop to the size of the cells
2) Optical method: detects the light scatter after a laser illuminates the cells passing through a flow cell, and cannot only count cells but identify what type of leukocyte is present based on the light scatter properties |
|
|
Term
| Why do you have to correct the leukocyte count for nRBCs? |
|
Definition
| -if present, nRBCs will be counted in the WBC count |
|
|
Term
| What is the formula for the corrected WBC count? |
|
Definition
| Corrected WBC count = nucleated cell count X (100/100+nRBCs) |
|
|
Term
| What is the purpose of the differntial leukocyte count? |
|
Definition
| -to determine the percentages of each leukocyte type present, which when multiplied by the leukocyte count will give you the absolute number of each leukocyte type per uL of blood |
|
|
Term
| What is the most numerous leukocytes in circulation? |
|
Definition
|
|
Term
| The earliest stage of granulocyte that can be identified in the bone marrow is the _____. |
|
Definition
|
|
Term
| True or False: After margination, neutrophils may exit the circulation and enter the tissues. This is a two-way migration. |
|
Definition
| -FALSE, this is a one-way migration |
|
|
Term
| What are the pools of neutrophils in the body? |
|
Definition
-proliferative pool
-mautration/storage pool
-circulating pool
-marginated pool |
|
|
Term
| The number of neutrophils in circulation at any point in time represents the balance between what two things? |
|
Definition
-production in the marrow
-utilization in tissues |
|
|
Term
| Neutrophils are an important part of the (acute/chronic) iflammatory process. |
|
Definition
|
|
Term
| Compare/contrast mature and band neutrophils. |
|
Definition
-Mature neutrophils: segmented with nuclei with clumped chromatin, faintly pink granular cytoplasm
-Band neutrophils: nuclei with parallel sides and no segments, nuclear chromatin is less mature (smoother, less clumped) |
|
|
Term
| What is the major functional difference between lymphocytes and neutrophils? |
|
Definition
| -lymphocytes do recirculate from blood to tissues and back to blood again while neutrophils do not re-enter the blood |
|
|
Term
| Visually describe lymphocytes. |
|
Definition
-round to oval nucleus with smudged chromatin and scanty pale blue cytoplasm, usually smaller than neutrophils
-reactive lymphocytes are recognized by their deep blue cytoplasm and more irregular nucleus and indicate antigenic stimulation |
|
|
Term
| What are the functions of moncytes? |
|
Definition
| -phagocytosis of microorganisms, cel debris, and foreign material |
|
|
Term
| Visually describe monocytes. |
|
Definition
| -nucleus can be almost any shape but it is frequently bean-shaped and has less clumped lacy chromatin compared to neutrophils, gray-blue and may contain vacuoles and very fine light-purple granules, larger than neutrophils |
|
|
Term
| Eosinophils are involved in what? |
|
Definition
| -involved in responses to parasitic infections and hypersensitivity responses |
|
|
Term
| Visual describe mature eosinophils. |
|
Definition
| -segmented nuclei and pale blue cytoplasm containing eosinophilic granules |
|
|
Term
|
Definition
| -decreased concentration in blood |
|
|
Term
| Definition: "-philia or -cytosis" |
|
Definition
| -increased concentration in blood |
|
|
Term
|
Definition
| -increased concentration of immature neutrophils in blood (absolute numbers are increased above the reference interval or neutropenia and >10% of neutrophils are immature) |
|
|
Term
| What are the two types of left shift? Describe them. |
|
Definition
a) Regenerative left shift: segmented neutrophils outnumber the immature forms
b) Degenerative left shift: immature forms outnumber the segmented neutrophils |
|
|
Term
| A regenerative left shift implies what? |
|
Definition
| -bone marrow is responding adequately to the inflammation and is winning hte war |
|
|
Term
|
Definition
| -morphologic change in the cytoplasm of neutrophils as a result of accelerated bone marrow production associated with severe inflammation wheter or not sepsis is onvolved |
|
|
Term
| What does toxic change look like? |
|
Definition
| -increased cytoplasmic basophilia, foamy vacuolation, toxic granulation, giant neutrophils, and donut neutrophils |
|
|
Term
| What are hypersegmented neutrophils? |
|
Definition
| -when neutrophils have 5 or more segmented loves and associated with aging |
|
|
Term
| What is a leukemoid response? |
|
Definition
| -extreme leukocytosis due to inflammation that mimics granulocytic neoplasia |
|
|
Term
| What is Pelger-Huet anomaly? |
|
Definition
-mimics a left shift
-inherited or acquired
-granulocytes of animals with this condition fail to develop normal nuclear segentations, and so may appear to be bands but the nuclear chromatin in these cells is mautre (nice and clumped) even though the nuclear shape looks immature |
|
|
Term
| Describe the inflammatory leukogram. |
|
Definition
| -neutrophilia with a regenerative left shit is most classic but can also have a degenerative left shift which is poor prognosti sign |
|
|
Term
| True or False: Magnitude of the toxic change roughly correlates with the severity of inflammation present. |
|
Definition
|
|
Term
| Describe a leukemoid response. |
|
Definition
| -extreme neutrophilia with a left shift |
|
|
Term
| True or False: Becuase cattle have low marrow reserved and slow proliferation capacity, the typical response to any acute inflammation is neutropenia. |
|
Definition
|
|
Term
| Describe an excitement leukogram. |
|
Definition
-refers to an immediate shift of cells from the marginated pool to the circulating pool that occurs after epinephrine release
-mautre neutrophilia and lymphocytosis with no left shit
-rule of thumb: mature neutrophilia up to 2X the upper end of the reference range is consistent with an excitement repsonse (potentially up to 3X in cats)
-most frequent in cats and hrooses |
|
|
Term
| Describe a stress/steroid/glucocorticoid leukogram. |
|
Definition
-associated with endogenous steroid release or exogenous steroid administration
-mature neutrophilia and lymphopenia withi or without monocytosis |
|
|
Term
|
Definition
-acute inflammation
-caused by decreased roduction in the bone marrow or, rarely, by immune-mediated peripheral destruction of neutrophils with no left shift |
|
|
Term
| What are some examples of chronic stem cell injuries resulting in pancytopenia? |
|
Definition
| -canine parvovirus, feline panleukopenia virus, ehrlichiosis, chemotherapeutics, estrogen, phenylbutazone |
|
|
Term
| What are some causes of lymphocytosis? |
|
Definition
-excitement leukogram, lymphocytic leukemia, lymphoma, etc
-lymphocytosis is greater than 20,000 the probability of leukemia is increased
-chronic canine ehrlichiosis with marked lymphocytosis |
|
|
Term
| True or False: The lack of lymphopenia in a sick animal becuase hypoadrenocorticism could be cause |
|
Definition
|
|
Term
| What is the most common cause of eosinophilia? |
|
Definition
| -parasites (ticks, fleas, nematodes, and trematodes, HW) and hypersensitivity reactions (asthma, dermatitis, eosinophilic gastroenteritis, and pulmonary infiltrate with eosinophilia) |
|
|
Term
|
Definition
| -the presence of neoplastic hematopoietic cells in the peripheral blood or bone marrow, and can be divided into myeloproliferative and lymphoproliferative disorders |
|
|
Term
| Compare/contrast myeloproliferative diorserds and lymphoproliferative disorders |
|
Definition
| -Myeloproliferative disorders arise from the stem cells in the bone marrow that produce all hematopoietic cells except lymphocytes, while lymphoproliferative disorders involve lymphoid cells in blood or bone marrow (lymphocytic leukemia, multiple myeloma) or tissues (lymphoma) |
|
|
Term
| What are some of the myeloproliferative disorders? |
|
Definition
| -leukemias affecting red cells, granulocytes, monocytes, and megakaryocytes |
|
|
Term
| What histological signs suggest the diagnosis of acute leukemia? |
|
Definition
| -marked leukocytosis with dosorderly maturation and blast cells |
|
|
Term
|
Definition
| -cytoplasmic fragments of megakaryocytes that are essential for hemostasis (non-mammalian species such as birds and reptles have thrombocytes instead of platelets) |
|
|
Term
| What is another problem with cat platelet conts? |
|
Definition
| -related to platelet size b/c they are typically twice the size of other species |
|
|
Term
| How do you roughly estimate platelet count? |
|
Definition
-use the 100X objective, count one platelet per field equally approximately 15,000-20,000 uL
-7010 platelets per field they should have adequate platelet function |
|
|
Term
| What is the only way to determine whether an anemia is regenerative or non-regenerative in horses? |
|
Definition
| -use bone marrow aspirate |
|
|
Term
| What does an increase in the M:E ratio indicate? |
|
Definition
-granulocytic hyperplasia or erythroid hypoplasia
-f PCV is low, then it is erythroid hypoplasia |
|
|
Term
| Name a few indications of bone marrow aspirate. |
|
Definition
| -unexplained cytopenias, potential malignancy involving marrow (leukemia, lymphoma, mast cell neoplasia), potential infection involving marrow, fever ofunknown origin, radiographic lytic bone lesions, unexplained hypercalcemia |
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