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Anatomy > Block 8 Exam > Flashcards

Block 8 Exam Flashcards

1
Q

What type of stain should be used for a blood smear?

A

Wright-Giemsa stain or similar

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2
Q

What is the RBC portion of a CBC called?

A

Erythrogram or hemogram

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3
Q

What is the job or RBC?

A

Carry O2 to cells and carry CO2 back to lungs

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4
Q

What is the equivalent term to hematocrit (HCT)?

A

PCV (packed cell volume)

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5
Q

What does anisocytosis mean?

A

Different sized RBC

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6
Q

What does polychromasia mean?

A

Different colors of RBC (blue)

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7
Q

What must be done prior to running a CBC with EDTA?

A

Blood needs to be mixed

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8
Q

If hematocrit is 45 what would you expect the hemoglobin to be?

A

Hemoglobin is 1/3 of the hematocrit
15

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9
Q

Are HCT and PCV the same?

A

Pretty similar but measured in different ways

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10
Q

How do you manually determine packed cell volume?

A

Microhematocrit tube

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11
Q

What does lipemic (milky) plasma indicate?

A

Often after eating, increased TP

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12
Q

What does hemolyzed (red) plasma indicate?

A

Rupture of RBCs during collected or from disease

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13
Q

What does icteric (yellow) plasma indicate?

A

Increased bilirubin (common in large animal

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14
Q

Are manual counting methods of RBC accurate?

A

No

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15
Q

What are reticulocytes?

A

Immature RBCs (larger and less hemoglobin)

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16
Q

What makes up the erythrocyte indices?

A

MCV = mean corpuscular volume
MCHC = mean corpuscular hemoglobin concentration

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17
Q

What is microcytic?

A

Decreased MCV

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18
Q

What is macrocytic?

A

Increased MCV

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19
Q

What is normocytic?

A

Normal MCV

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20
Q

What is MCHC?

A

Ratio of hemoglobin to a volume of RBC

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21
Q

What is a low MCHC? What is it associated with?

A

Hypochromic
Regenerative response from iron deficiency

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22
Q

What is an increased MCHC due to?

A

Artifact

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23
Q

What is RDW

A

RBC distribution width
Numerical expression of variation in RBC size (anisocytosis)

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24
Q

What does decreased hematocrit mean?

A

Anemia

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25
Q

What determines if anemia is regenerative or non regenerative?

A

Reticulocytes

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26
Q

What is the first thing to do on a blood smear?

A

Evaluate quality of blood smear grossly

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27
Q

Where should you go on a blood smear to evaluate the cells?

A

Counting area

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28
Q

What shape are camelid’s RBC?

A

Oval

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29
Q

What is unique about birds and reptiles RBC?

A

They’re nucleated

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30
Q

What is it called when RBCs are in a row?

A

Rouleaux formation

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31
Q

What species can a Rouleaux formation be normal in?

A

Cats and horses

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32
Q

What does a Rouleaux formation indicate?

A

Increased proteins due to inflammation

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33
Q

What are irregular clumps of RBCs due to antibody coating called?

A

Agglutination

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34
Q

What does agglutination often indicate?

A

IMHA

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35
Q

What should you do if you can’t differentiate a Rouleaux formation from agglutination?

A

Saline will disperse rouleaux formations but not agglutination

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36
Q

What is a variation in RBC size called?

A

Anisocytosis

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37
Q

What is polychromasia?

A

Larger, bluer cells that are immature RBCs

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38
Q

What does increase polychromasia indicate?

A

Regenerative response to anemia

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39
Q

What is the difference between polychromasia and reticulocytes?

A

Polychromasia is used when stained with Wright-Giemsa
Reticulocytes is used when stained with new methylene blue

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40
Q

What are punched out or bowl cells?

A

Artifact

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41
Q

What is basophilic stippling?

A

Punctate basophilic granules that consist of ribosomes and poly ribosomes (Circular with blue dots on the inside)

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42
Q

What does basophilic strippling indicate?

A

Regenerative anemia in ruminants
Lead toxicity in dogs

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43
Q

What do nucleated RBCs indicate with reticulocytes?

A

Just part of regenerative response

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44
Q

What are Howell-Jolly Bodies?

A

Nuclear fragment resulting in round, basophilic bodies in RBC

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45
Q

What would a Howell-Jolly body indicate?

A

Increased in some regenerative anemias

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46
Q

What are spherocytes?

A

RBCs are smaller and lack a central zone of pallor (white zone)

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47
Q

What do spherocytes indicate?

A

They form when antibodies bind to RBCs and part of the RBC is phagocytized in the spleen

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48
Q

What disease do spherocytes appear in?

A

IMHA

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49
Q

What is the term for RBCs with abnormal shapes?

A

Poikilocytes

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50
Q

What is the term used for RBCs that become poikilocytes through mechanical trauma?

A

Schistocytes

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51
Q

What is the poikilocyte with 1-2 projections on RBC surface?

A

Keratocytes

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52
Q

What are keratocytes from?

A

Physical or chemical injury
Also iron deficiency anemia and liver disease

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53
Q

What is the poikilocyte that has thorny projections from it?

A

Acanthocytes

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54
Q

What are acanthocytes caused by?

A

Abnormal RBC membrane lipids
Liver disease, hemangiosarcoma, DIC

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55
Q

What is the poikilocyte that have uniformly spaced projections?

A

Echinocyte
Usually an artifact

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56
Q

What are cells with a dot in the middle of the central zone?

A

Leptocytes

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57
Q

What are differentials for leptocytes?

A

Liver disease, hypothyroidism, iron deficiency

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58
Q

What is an oxidized hemoglobin protrusion from RBC surface?

A

Heinz bodies

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59
Q

What induces Heinz bodies?

A

Oxidants, drugs, and toxins
Stain better with new methylene blue

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60
Q

What are erythrocytes where hemoglobin is condensed on one side of the cell?

A

Eccentrocytes

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61
Q

What causes eccentrocytes?

A

Zinc to toxicity
Red maple leaf toxicity

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62
Q

What are tear-drop shaped RBCs?

A

Dacryocytes

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63
Q

When are dacryocytes seen?

A

Sick camelids

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64
Q

What are mouth-like slits in RBCs?

A

Stomatocytes
Artifact

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65
Q

What 3 things will be decreased in an anemia patient?

A

PCV (HCT)
Hemoglobin (Hgb) concentration
RBC count

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66
Q

What is used most commonly in veterinary medicine to measure RBC amount?

A

PCV (HTC)
Accurate and cheap

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67
Q

What causes anemia?

A

RBC loss or destruction is faster than RBC production or RBC production is decreased

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68
Q

What will PCV and TP be if P is dehydrated (Increased or decreased)?

A

Increased

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69
Q

What is increased TP and PCV due to dehydration called?

A

Relative polycythemia

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70
Q

What happens to TP and PCV with over hydration?

A

Decreased TP and PCV

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71
Q

What is decreased TP and PCV from overhydration called?

A

Relative anemia

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72
Q

What are clinical signs of anemia?

A

Weakness, hyperpnea, pale MM +/- icterus, tachycardia or murmur, and fever

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73
Q

What can red or reddish brown urine indicate?

A

Anemia
Hematuria: blood in urine
Hemoglobinuria: Hemoglobin in urine from hemolysis

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74
Q

What does dark yellow urine indicate?

A

Anemia
Bilirubinuria: bilirubin in urine

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75
Q

What does melena (digested food in feces) indicate?

A

Anemia

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76
Q

What is the regenerative response to anemia in the bone marrow?

A

Erythropoiesis

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77
Q

What number helps you determine if the anemia is regenerative or non-regenerative?

A

Reticulocytes

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78
Q

What does increased reticulocytes indicate?
What do normal reticulocytes numbers indicate?

A

Regenerative: A bone marrow response to replace RBCs
Non-regenerative

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79
Q

What are common regenerative anemia diseases?

A

Acute hemorrhage or hemolysis

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80
Q

What are common non-regenerative anemia diseases?

A

Chronic diseases: CKD or primary bone marrow disease

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81
Q

What is physiological reticulocytosis

A

Dogs may release reticulocytes from excited or after exercise

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82
Q

Are reticulocytes reliable in ruminants?

A

No, use basophilic strippling instead

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83
Q

Are reticulocytes reliable to use in horses?

A

No, use a serial MCV and RDW (over several days) to asses regeneration

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84
Q

How long after acute damage does a reticulocytes response occur?

A

3-5 days

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85
Q

What other 2 characteristics do anemic hemograms usually show?

A

Macrocytic and hypochromic

Nonregenerative are usually normocytic and normochromic

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86
Q

What is another reason (besides regenerative anemia) that a patient would be macrocytic and hypochromic?

A

Iron deficiency anemia

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87
Q

What would microcytic normochromic RBCs indicate?

A

Portosystemic shunt

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88
Q

What would macrocytic and normochromic RBCs indicate?

A

Horses with regenerative anemia
Cats w/ FeLV infection

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89
Q

What are the 3 classification schemes for anemia?

A

Reticulocytes count
RBC indices
Pathogenesis

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90
Q

What is hemolysis?

A

RBC destruction

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91
Q

What is the term for decreased platelets?

A

Thrombocytopenia

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92
Q

Is iron deficiency regenerative or nonregenerate

A

Either

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93
Q

How are WBCs evaluated?

A

Under a microscope

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94
Q

What are the 3 granulocytes?

A

Neutrophils
Eosinophils
Basophils

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95
Q

What is a synonym to leukocytes?

A

WBC

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96
Q

What are lymphocytes?

A

T and B cells

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97
Q

What are the characteristics of a neutrophil?

A

Granulocyte
Smaller than a monocyte
Larger than a lymphocyte
Multiple lobes

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98
Q

What are neutrophils called in birds, reptiles, rabbits, and Guinea pigs due to their reddish granules?

A

Heterophobia

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99
Q

What is the function of neutrophils?

A

Phagocytosis and killing bacteria (inflammation)

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100
Q

What is the definition of a left shift?

A

An increase in band neutrophils

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101
Q

When would banded neutrophils increase?

A

During inflammation

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102
Q

What is eosinophil morphology?

A

Larger than neutrophil
Bright pink granules

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103
Q

What is the function of eosinophils?

A

Granule released are cytotoxic to parasites and tumor cells
Increase with worms wheezes and weird diseases

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104
Q

What do basophils look like?

A

Poorly segmented, ribbon-like nucleus, dark purple granules

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105
Q

What is the function of basophils?

A

Defend against helminths, histamine release

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106
Q

What is the morphology of monocytes?

A

Largest leukocyte
Kidney bean appearance
Contains vacuoles

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107
Q

What is the function of monocytes?

A

Leave blood to become macrophages
Defend against bacteria, fungi, and Protozoa
Process and present antigen to T lymphocytes

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108
Q

What are lymphocyte morphologies?

A

Larger than RBCs, smaller than neutrophils
Very large nucleus

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109
Q

What is the function of B lymphocytes?

A

Humoral immunity
Plasma cells secrete antibodies

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110
Q

What is the function of T lymphocytes?

A

Cell mediated immunity
CD4 (activate B cells), CD8 (kill damaged cells), NK cells

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111
Q

What are the different pools in bone marrow?

A

Proliferating pool
Maturation and storage pool

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112
Q

What are the different pools in blood?

A

Marginating pool
Circulating pool

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113
Q

What is the function of the proliferating pool?

A

Can divide (myeloblasts, promyelocytes, myelocytes)

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114
Q

What is the function of the maturation / storage pools?

A

Allows for development and a reserve of neutrophils

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115
Q

What is the marginating granulocyte pool?

A

Cells adhere to vessel walls, ready to move to tissues

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116
Q

What is the circulating granulocyte pool?

A

What you sample when you sample blood (cells move back and forth between marginal granulocyte pool and circulating granulocyte pool)

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117
Q

What happens after neutrophil enter tissue?

A

Cannot recirculate, live for 1-4 days then die

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118
Q

Are lymphocytes long lived and continuously recirculate?

A

YES

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119
Q

What is toxic change in neutrophils?

A

Caused by intense granulopoiesis in bone marrow, usually caused by marked inflammation. Neutrophils have less time to mature so they retain som ribosomes and rough ER

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120
Q

What is a toxic change with blue inclusions of rough ER and is often the earliest indication of toxic change?

A

Dohle bodies

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121
Q

What are additional indication of toxic neutrophils?

A

Foaminess and larger nuclear lobes

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122
Q

What is the ladder of severity of toxic change?

A

Dohle Bodies<Basophilia<Foaminess<Granules

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123
Q

What is the prognosis when there is severe toxic change?

A

Poor

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124
Q

What is a synonym to regenerative left shift?

A

Appropriate left shift

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125
Q

What is the definition of a regenerative left shift?

A

Segs>bands

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126
Q

What is a degenerative left shift?

A

Bands>Segs

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127
Q

What might you see in the neutrophils of degenerative left shift?

A

Toxic change, myelocytes, and meta myelocytes

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128
Q

What are hypersegmented neutrophils?

A

5+ nuclear lobes

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129
Q

What are causes of hypersegmented neutrophils?

A

Corticosteroids, chronic inflammation, leukemia

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130
Q

What is it called when neutrophils have a failure to segment so cells resemble bands?

A

Pelger-Huet anomaly

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131
Q

Is Pelger-Huet Anomaly an issue?

A

No but dont misdiagnose as a left shift

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132
Q

What are the Big Bad Blue cells?

A

Blast cells

133
Q

What are blast cells associated with?

A

Leukemia

134
Q

During a leukocyte differential, what should you do if there are a lot of WBC present?

A

Count more cells to increase accuracy

135
Q

During a leukocyte differential, how many cells should you count in the mono layer?

A

Count 100-200 cells

136
Q

Can instruments distinguish nRBCs from WBCs?

A

No

137
Q

What is the term for increased circulating WBCs?

A

Leukocytosis

138
Q

What is the term for decreased circulating WBCs?

A

Leukopenia

139
Q

What is the term for increased neutrophils, basophils, and basophils?

A

Neutrophilia, eosinophilia, and basophilia

140
Q

What is the term for decreased neutrophils and eosinophils?

A

Neutropenia and eosinopenia

141
Q

What is the term for increased lymphocytes and monocytes?

A

Lymphocytosis and monocytosis

142
Q

What is the term for decreased lymphocytes and monocytes?

A

Lymphopenia and monopenia

143
Q

What is the most numerous WBC in dogs and cats?

A

Neutrophils

144
Q

What is the most numerous WBC in ruminants?

A

Lymphocytes

145
Q

What is the most numerous WBC in horses?

A

Lymphocytes roughly equal to neutrophils

146
Q

What are 2 reasons for a non-pathological leukocytosis?

A

Epinephrine (excitement, exercise)
Corticosteroid (s=stress)

147
Q

What are 2 reasons for a pathological leukocytosis?

A

Inflammation
Leukemia

148
Q

What is the term for decreased WBC?

A

Leukopenia

149
Q

Is leukopenia always pathological?

A

YES

150
Q

What does leukopenia indicate?

A

Increased utilization, decreased production

151
Q

What are the 2 causes for non-pathological neutrophilic

A

Epinephrine (Excitement, Exercise)
Corticosteroid (Stress neutrophilia)

152
Q

What are the two pathological reasons for neutrophilia?

A

Inflammation/infection
Neoplasia

153
Q

What happens to the neutrophil pool when there is a epinephrine release?

A

Neutrophils shift from marginal pool to circulating pool

154
Q

What is the most common species to show a physiological leukogram?

A

CATS (from blood draws)

155
Q

What is stress neutrophilia?
What is physiologic neutrophilia?

A

Stress = corticosteroids
Physiologic = epinephrine

156
Q

Where do the neutrophils in a stress neutrophilia come from?

A

The bone marrow storage pool (no increased production)

157
Q

What type of neutrophil may show up in a stress neutrophilia?

A

Hypersegmented neutrophils

158
Q

What is neutrophilia caused by inflammation or infection called?

A

Reactive neutrophilia

159
Q

What does reactive neutrophilia do to pools?

A

Increased production and release from bone marrow, increased marginal pool, and increased migration into tissues

160
Q

What will chronic inflammatory neutrophilia show up as?

A

Left shift is diminished, granulocyte hyperplasia (increased BM production) has restored the storage pool

161
Q

What are some common causes of neutrophilia by inflammation?

A

Infectious agents (bacteria)
Hemolysis
Trauma
IMHA
Envenomation

162
Q

What happens to neutrophil numbers during neoplasia?

A

Extreme neutrophilia/leukocytosis

163
Q

What species has the largest neutrophil response?

A

Pigs

164
Q

What is the word for “leukemia-like”, but not

A

Leukemoid

165
Q

How do you know a leukemoid response isn’t leukemia?

A

Other evidence of inflammation (pyometra, pyothorax, etc)
Lack of thrombocytopenia
Improves over time

166
Q

Is neutropenia (low neutrophils) always pathological?

A

YES

167
Q

What does neutropenia indicate?

A

Over consumption of neutrophils (chronic)
Peripheral destruction
Increased margination

168
Q

Why is neutropenia more common in cattle?

A

Smaller storage pools

169
Q

Why is neutropenia associated with increased consumption

A

Severe inflammation overwhelms the BM’s ability to respond

170
Q

What causes increased margination during neutropenia?

A

Endotoxemia (LPS produced by bacteria)

171
Q

What is increased eosinophils called?

A

Eosinophilia

172
Q

What causes eosinophilia?

A

Words (parasites), wheezes (allergies), and weird diseases

173
Q

What 2 parasites can cause eosinophilia?

A

Ectoparasites
Heartworms

174
Q

What “wheezes” can cause eosinophilia

A

Allergies

175
Q

What “weird diseases” can cause eosinophilia?

A

Addison’s disease
Neoplasm (mast cell tumor)

176
Q

What is most common cause of basophilia in dogs?

A

Hearworm

177
Q

What affect does epinephrine have on lymphocytes?

A

Lymphocytosis (increased lymphocytes) from a shift to the circulating pool from the marginal pool

178
Q

What are the 5 causes of Lymphocytosis?

A

Physiological (epinephrine)
Age
Antigenic stimulation/inflammation
Addison’s Disease
Neoplasia

179
Q

Why does age cause Lymphocytosis?

A

Higher lymphocytes circulating in young animals

180
Q

Why does antigenic stimulate cause Lymphocytosis?

A

Post vaccination
Fighting infection

181
Q

Why does Addison’s disease cause Lymphocytosis?

A

Decreased glucocorticoids normally inhibit lymphocyte production
*** Always think Addison’s disease in a sick dog with Lymphocytosis because stress should cause lymphopenia

182
Q

What is the most often cause of lymphopenia?

A

Stress leukogram! (Also Cushings)
VERY IMPORTANT

183
Q

What is LEMN?

A

Low Lymphocytes and eosinophils
More monocytes and neutrophils
******

184
Q

What are the 3 most common leukogram patterns?

A

Physiologic leukogram (epinephrine)
Stress leukogram (corticosteroids)
Inflammatory leukogram

185
Q

What can acute inflammation in a cow cause?

A

Neutropenia and degenerative left shift due to small BM reserve of mature neutrophils

186
Q

Why should a physiologic leukogram not have a left shift?

A

No increased release of neutrophils, just shifting from marginal pool to circulating pool so no bands

187
Q

What is increased in a physiologic leukogram?

A

Neutrophilia
Lymphocytosis

188
Q

What happens in an inflammatory leukogram early?

A

Leukopenia due to migration from marginal pools into tissues

189
Q

What happens in an inflammatory leukogram later?

A

Granulocytic hyperplasia (increased production of leukocytes) resulting in neutrophilia

190
Q

What is hemostasis?

A

Coagulating “clotting”

191
Q

What does deficient coagulation result in?

A

Hemorrhage

192
Q

What does excessive coagulation result in?

A

Thrombosis

193
Q

What doe endothelial cells produce during vascular damage?

A

von Willebrand factor(vWf)
Tissue factor
Plasminogen activator inhibitors

194
Q

What is a platelet’s morphology?

A

Clear, membrane bound fragments of cytoplasm without a nucleus

195
Q

What is the function of platelets?

A

Hemostasis - form a plug

196
Q

What is the equivalent of platelets in birds and reptiles?

A

Thrombocytes

197
Q

What is the con Willebran factor receptor?

A

Glycoprotein Ib (GPIb)

198
Q

What is the fibrinogen receptor?

A

Glycoprotein IIB/IIIa (GP11b/111a)

199
Q

What is the purpose of GPIb

A

Binds to the subendothelium initially

200
Q

What is the purpose of GPiib/iiia?

A

Binds platelets to fibrinogen

201
Q

How are platelets produced?

A

Anucleat fragments that are produced by a megakaryocyte

202
Q

What’s the first thing that happens during vascular damage?

A

Vasocontriction - brief/transient; slows blood flow

203
Q

What happens after vasocontriction during vascular damage?

A

Primary hemostasis

204
Q

You’re gonna be ok

A
205
Q

What happens after primary hemostasis during vascular damage?

A

Secondary hemostasis

206
Q

What is the last step during vascular damage?

A

Fibrinolysis

207
Q

What are the 3 sites for bone marrow sampling in small animals?

A

Iliac crest
Proximal femur
Proximal humerus

208
Q

Where do you sample bone marrow in a large animal?

A

Sternum

209
Q

What size needle do you use for bone marrow collection?

A

16 or 18 gauge needle

210
Q

What type of stylets do you use for bone marrow collection?

A

Rosenthal, Illinois sternal, or Jamshidi

211
Q

What type of syringe do you use for BM collection?

A

EDTA or heparin

212
Q

What’s difference between BW aspirate and BM core?

A

BM aspirate = cytology
-better cellular detail
BM core = histology
-better architecture

213
Q

What’s the first step of primary hemostasis?

A

Platelets bind to subendothelium through GB1b binding to van Willebrand factor

214
Q

What happens in primary hemostasis after platelet adhesion?

A

Platelets change shape, activate, and release granule for recruitment

215
Q

What is the final step in primary hemostasis?

A

Platelet plug formation

216
Q

What is secondary hemostasis?

A

Stabilization of platelet plug

217
Q

What is the MPV?

A

Mean platelet volume (average size of platelet

218
Q

What is platelet evaluation?

A

Estimate number of platelets on slide

219
Q

What 2 different tubes should be used to analyze platelet numbers?

A

Either EDTA or sodium citrate

220
Q

What happens if there are clumps in the thrombogram?

A

Artificially decrease thrombocytes

221
Q

What would a patient with platelets below 20-30 be at risk of?

A

Risk of spontaneous hemorrhaging

222
Q

What’s the equation to estimate the platelets on a hemocytometer?

A

Multiple avatar on 100x field by 20 x 109/L

223
Q

What is a decrease of macrothrombocytes called?

A

Macrothrombocytopenia

224
Q

What breeds is macrothrombocytopenia common in?

A

Cavalier King Charles Spaniels

225
Q

What is the only test of platelet function that is normally done in clinics?

A

BMBT: Buccal mucosal bleeding time

226
Q

What is BMBT?

A

Small cut in buccal mucosa to evaluate time until bleeding stops

227
Q

What is normal BMBT in dogs? Cats?

A

Dog: 1-5 min
Cats: 1-3.5 min

228
Q

What does an increased BMBT mean?

A

Decreased platelets OR platelet dysfunction

229
Q

When should you perform a BMBT?

A

Platelet numbers are known but platelet function is questioned

230
Q

Will disorders of secondary hemostasis affect BMBT times?

A

NO!!

231
Q

What is asymptomatic thrombocytopenia?

A

Generally low platelet counts in health without causing spontaneous hemorrhage

Tend to have high MPV (mean platelet volume) due to macro platelets

232
Q

What is the most common disorder that affects primary hemostasis?

A

Thrombocytopenia

233
Q

What are less common causes of impaired primary hemostasis?

A

Decreased impaired platelet function (von willebrand disease)

234
Q

What are some 4 clinical signs of a primary hemostasis disorder?

A

Petechia (small red spots)
Ecchymoses (large red spot)
Spontaneous mucosal bleeding (epistaxis, gingival bleeding)
Prolonged bleeding

Epistaxis = nose bleed

235
Q

What is the first step to evaluate primary hemostasis disorder?

A

Determine total platelet count

236
Q

What is second step, after platelet numbers come back normal, to determine primary hemostasis disorder?

A

Determine platelet function (BMBT)

237
Q

What does an increased MPV and macro platelets suggest?

A

Immature platelets due to platelet regeneration

238
Q

What are 3 main causes of thrombocytopenia?

A

Consumption: Utilization during hemostasis
Destruction: Immune mediated thrombocytopenia
Decreased production: Damage to BM or megakaryocytes not produced

239
Q

Does hemorrhage cause decreased platelet count?

A

No, blood loss doesn’t cause decreased platelet but they are consumed during hemostasis

240
Q

What is a disease associated with consumption of platelets?

A

Disseminated intravascular coagulation: Uncontrolled coagulation throughout body

241
Q

What is a disease associated with destruction of platelets?

A

Immune mediated thrombocytopenia (ITP)

242
Q

What is ITP?

A

Immune mediated thrombocytopenia caused by body producing antibodies against platelets

Equal to IMHA for RBCs

243
Q

What animals have ITP more often

A

Dogs
Cocker spaniels
Females

244
Q

What is Evan’s syndrome?

A

Concurrent IMHA and ITP

245
Q

What happens in bone marrow during ITP?

A

Increased megakaryocytes in bone marrow aspirate

246
Q

What are lab findings associated with decreased production leading to thrombocytopenia?

A

No macroplatelets in circulation
Decreased megakaryocytes in BM

247
Q

What are the cells in the BW that produce macroplatelets and thus platelets?

A

Megakaryocytes

248
Q

What is von Willebrand disease?

A

Defective and/or deficient vWf

249
Q

How do you test for decreased vWf?

A

Quantitative ELISA

250
Q

What happens if NSAIDS and aspirin are given to a dog?

A

Inactivated platelets through blocking of thromboxane production.

Thromboxane (TXA2) is needed to activate GPIIb/IIIa which binds fibrinogen and allows for aggregation

251
Q

Is the effect of aspirin reversible?

A

No, lasts 7 days

252
Q

Are the effects of NSAIDs reversible?

A

Yes

253
Q

What are the two general causes of thrombocytosis?

A

Physiologic: Epinephrine induced
Reactive: Secondary to inflammation

254
Q

What causes physiologic thrombocytosis?

A

Release of epinephrine causes splenic contraction (production is not increased)

255
Q

What is reactive thrombocytosis?

A

Increased production from increased megakaryocytes in BM. Often have increased MPV

256
Q

What might be seen in platelet numbers with an iron deficiency?

A

Increased platelet production (unknown reason)

257
Q

What is the “glue” that holds platelets together during hemostasis?

A

Fibrin

258
Q

When is the fibrin formed in hemostasis?

A

Secondary hemostasis

259
Q

What is the goal of secondary hemostasis?

A

Formation of cross-linked fibrin

260
Q

What is the coagulation factor needed in secondary hemostasis?

A

Thrombin (II)

261
Q

What are the pathways of the coagulation cascade?

A

Intrinsic
Extrinsic
Common

262
Q

What does the extrinsic pathway do?

A

Initiatives coagulation and forms a small amount of thrombin

263
Q

What is the intrinsic pathway?

A

Amplifies coagulation and forms a large amount of thrombin

264
Q

What are the factors of the intrinsic pathway?

A

12, 11, 9, 8

265
Q

What are the factors of the extrinsic pathway?

A

Factor 7

266
Q

What is the goal of the coagulation cascade?

A

To get a cross-linked fibrin

267
Q

What are the different phases of fibrin?

A

Fibrinogen>fibrin>crosslinked fibrin

268
Q

What converts fibrinogen to soluble fibrin?

A

Thrombin

269
Q

What factor cross links fibrin to a non-soluble fibrin polymer needed for stability of clotting?

A

Factor 8a

270
Q

What coagulation factors need vitamin K to become fully functional?

A

2, 7, 9, 10

271
Q

What happens if there is a vitamin K deficiency

A

No vitamin K to help form crosslinked fibrin
SEVERE hemorrhagic disorder

272
Q

What is a necessary coagulation inhibitor?

A

Antithrombin III (ATIII)

273
Q

What pathway does Antithrombin inhibit? What factors?

A

Intrinsic and common pathway
Inhibits thrombin, 9a, 10a, and 11a

274
Q

What activates Antithrombin (ATIII)?

A

Heparin

275
Q

What is fibrinolysis?

A

Enzymatic lyses of fibrin clot
Prevention of unchecked clotting

276
Q

What is the fibinolytic (fibronlysis) enzyme?

A

Plasmin

277
Q

What are the products from the breakdown of fibrin and fibrinogen?

A

Fibrin degradation products (FDP)

278
Q

What are the products from the breakdown of cross-linked fibrin via plasmin?

A

D-Dimers

279
Q

Where are the major abnormalities for bleeding disorders in secondary hemostasis?

A

Coagulation factors

280
Q

What tube is used to determine coagulation cascade assays?

A

Sodium citrate tube for PT and aPTT

281
Q

What tube can you not use for coagulation cascade assay? Why?

A

EDTA because EDTA binds Calcium irreversibly

282
Q

Why can you use sodium citrate tubes for coagulation tests?

A

Sodium citrate is a reversible anticoagulant (not as effective as EDTA at binding Ca)

283
Q

What test is used for intrinsic and common pathway?

A

Activated partial thromboplastin time (aPTT)

284
Q

What test is used for extrinsic and common pathways?

A

Prothrombin time (PT)

285
Q

What factors are in the common pothway?

A

X, V, II (prothrombin), fibrinogen (I)

286
Q

Is aPTT and PT prolonged by thrombocytopenia?

A

NO

287
Q

What factor has the shortest half-life of vitamin K dependent factors?

A

7

288
Q

What causes increased FDPs and D dimers

A

DIC, hemorrhage, thrombosis (clots are being broken back down after they form)

289
Q

What causes decreased clearance of FDPs and D-dimers?

A

Liver disease / failure

290
Q

What does a normal coagulation panel measure?

A

PT
APTT

291
Q

What is thromboelastography (TEG)

A

Detects hypercoagulability

292
Q

What are two reasons secondary hemostasis (coagulation cascade) would be abnormal?

A

Abnormal structure
Decreased coagulation factors

293
Q

What are clinical signs of secondary hemostatic disorders?

A

Hematomas - very common
Hemoabdomen / hemothorax
Bleeding initially stops (primary plug) then starts again

294
Q

What is hemophilia?

A

Bleeding disorder due to an inherited deficiency of a clotting factor

295
Q

What is inherited deficiency of clotting factor 8-12

A

Hemophilia A = factor VIII
Hemophilia B = factor IX
Hemophilia C = factor XI
Factor XII deficiency

296
Q

What hemophilia types have severe hemorrhaging issues?

A

Hemophilia A and B

297
Q

What is factor I?

A

Fibrinogen

298
Q

What is more common in secondary hemostasis disorders, development of a disorder or inherited disorder?

A

Inherited disorder

299
Q

What factors would a vitamin K impair?

A

Factors II, VII, IX, and X

300
Q

What are 3 reasons for a vitamin K deficiency?

A

Decreased production
Malabsorption
Vitamin K antagonism

301
Q

What are vitamin K antagonists?

A

Anticoagulants like moldy sweet clover in cows and rodenticides (Warfarin)

302
Q

Why is PT affected most in a vitamin K deficiency?

A

Because PT is affected first and worst because Factor VII has shortest half life!

303
Q

What would liver disease do to PT and aPTT?

A

Prolong both because the liver produces most coagulation factors including fibrinogen

304
Q

What is a mixed hemostatic disorder?

A

Bleeding disorder with abnormalities in primary hemostasis, secondary hemostasis, and fibrinolysis

305
Q

What is the most common mixed hemostatic disorder?

A

Disseminated Intravascular Coagulation (DIC)

306
Q

What is thrombosis?

A

Widespread formation of clots

307
Q

What is DIC?

A

Consumption of coagulation proteins, antithrombotic proteins, and platelets, often enhanced fibrinolysis

308
Q

What is DIC caused by?

A

ALWAYS secondary to another pathology

309
Q

What diseases cause DIC?

A

Infection/sepsis
Heart worm
Heat stroke
GDV

310
Q

What causes DIC in horses and ruminants?

A

Endotoxemia or sepsis

311
Q

What poikilocyte is common in DIC?

A

Schistocyte: Has to squeeze through clots

312
Q

What are top differential that all need to happen together to suspect DIC?

A

Prolonged PT
Prolonged aPTT
Thrombocytopenia

313
Q

How do you treat DIC?

A

Treat primary disease

314
Q

What 3 things should be found in BW?

A

Fat, iron, and hematopoietic tissue

315
Q

What is an ME ratio?

A

Myeloid to (nucleated) erythroid cells

316
Q

What is a normal M:E ratio?

A

1-2

317
Q

What is myeloid hyperplasia?

A

Myeloid is WBC so Myeloid hyperplasia in neutropenia situations

318
Q

What does PIMA stand for?

A

Precursors-targeted immune mediated anemia
AKA nonregenerative IMHA

319
Q

What does PIMA do?

A

Auto immune attack of red blood cell precursors
IMHA is attack on mature red blood cells

320
Q

What 3 zones are in the adrenal gland?

A

Zone glomerulosa
Zona Fasciculata
Zona reticularis

321
Q

What does the Zona glomerulosa produce?

A

Mineralcorticoids

322
Q

What does the Zona fasciculata produce?

A

Glucocorticoids

323
Q

What does the Zona reticularis produce?

A

Androgens

324
Q

What does the medulla produce?

A

Catecholamines

325
Q

What is an example of glucocorticoids? And function?

A

Cortisol
Related to carbs and protein metabolism

326
Q

What is an example of mineralcorticoids and what is its function?

A

Aldosterone
Related to electrolyte and water metabolism

327
Q

What are androgens?

A

Sex hormones

328
Q

Which glucocorticoid has the lowest activity?

A

Corticosterone

329
Q

What is clotting factor II?

A

Prothrombin

Anatomy (26 decks)

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