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ACVIM SAIM (2023) > Clinical Pathology > Flashcards

Clinical Pathology Flashcards

1
Q

A fear/excitement response is characterized by what leukogram changes?

A

Mature neutrophilia, lymphocytosis, leukocytosis, erythrocytosis

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2
Q

A stress leukogram is characterized by what leukogram changes?

A

Mature neutrophilia, lymphopenia, monocytosis (in dogs), eosinopenia

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3
Q

After iron is removed from transferrin in the cell, in what form is it recycled back to the cell surface?

A

Apotransferrin

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4
Q

anisocytosis

A

variability in cell size

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5
Q

Anisokaryosis

A

Variation in nuclear size

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6
Q

Biliverdin is reduced to what molecule?

A

Bilirubin, which then binds to albumin in plasma for transport to the liver and is excreted in bile

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7
Q

Categories of primary hemostatic disorders (3)

A
  • Not enough platelets
  • Platelets not working
  • Not enough von Willebrand factor
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8
Q

Causes of inappropriate secondary polycythemia

A
  • Renal neoplasia
  • Neoplasia causing aberrant EPO secretion
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9
Q

Cytologic criteria of malignancy

A
  • Cellular pelomorphism (anisocytosis, anisokaryosis)
  • Increased or more variable N:C ratio
  • Binucleation and multinucleation (or variable nuclear sizes w/in one cell)
  • Abnormal nuclear shape
  • Nucleoli (more prominent, large, variably sized, and/or multiple nucleoli)
  • Altered chromatin pattern (less condensed - often stippled or coarse)
  • Bizarre mitotic figures
  • Increased basophilia (darker blue)
  • Atypical vacuolation or inclusions
  • Loss of normal components (ex: melanin)
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10
Q

DDAVP is not effective in what type of vWF disease?

A

Type 3 - b/c all it does is enhance release, and these dogs have no vWF

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11
Q

Ddx for high AG metabolic acidosis

A

Ketoacidosis
Lactic acidosis
Uremic acidosis
Intoxication (ethylene glycol, salicylates, metaldehyde, others)

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12
Q

Ddx for hypercalcemia

A

D - vit D toxicosis
R - renal failure
A - Addisons
G - Granulomatous dz
O - Osteolysis
N - Neoplasia
S - Spurious
H - Hyperparathyroidism
I - Iatrogenic/idiopathic
T - Toxins

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13
Q

Ddx for hypocalcemia

A
  • Hypoalbuminemia (distributional change)
  • Primary hypoparathyroidism
  • Secondary hypoparathyroidism (renal, nutritional)
  • Hypovitaminosis D
  • Ethylene glycol toxicity (acute RF + calcium oxalate crystal formation)
  • Acute pancreatisis
  • Pregnancy and lactation
  • EDTA anticoagulant
  • Citrate anticoagulant
  • Acidosis
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14
Q

Ddx for hypoglycemia

A
  1. Increased glucose utilization
  2. Decreased glucose production
  3. LAB ERROR
  4. Starvation
  5. Hepatic insufficiency
  6. Portosystemic shungs
  7. Addisons
  8. Sepsis
  9. Insulinoma or other neoplasia (usually IGF-1 secreting)
  10. Pregnancy toxicosis/ketosis
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15
Q

Ddx for metabolic alkalosis

A
  • Hypochloremic alkalosis (loop/thiazide diuretics, vomiting, iatrogenic from sodium bicarb administration)
  • Concentration alkalosis (pure water loss, hypotonic fluid)
  • Chloride-resistant alkalosis (Cushings, hyperaldosteronism)
  • Hypoalbuminemic alkalosis (PLE, PLN, hepatic synthetic failure)
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16
Q

Ddx for normal AG (hyperchloremic) metabolic acidosis

A

Addisons
DIarrhea
Renal tubular acidosis
Post-hypocapnia
Iatrogenic (carbonic anhydrase inhibitors, ammonium chloride, TPN)

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17
Q

Ddx for respiratory acidosis

A

Large airway obstruction
Small airway disease (asthma, chronic bronchitis)
Pulmonary parenchymal disease (CHF, pneumonia)
Restrictive pleural space diseases
Neuromuscular disorders causing respiratory muscle failure
Increased CO2 production with concurrent hypoventilation (heatstroke)
Iatrogenic (mechanical underventilation)
Marked obesity

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18
Q

DDx for respiratory alkalosis

A
  • Hypoxemia –> stimulation of peripheral chemoreceptors
  • Non-hypoxemic activation of pulmonary stretch/nociceptors (pulmonary embolism, pulmonary fibrosis, pulmonary edema)
  • Activation of central respiratory centers –> hyperventilation
  • Iatrogenic from overzealous mechanical ventilation
  • Sepsis
  • Fever
  • Fear/pain/anxiety
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19
Q

Decreased folate indicates what?

A

Disease of the proximal small intestine (dietary deficiency, uncommon)

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20
Q

Differentials for hyperglycemia

A
  1. Diabetes (decreased uptake into cells)
  2. Stress (corticosteroids antagonize insulin and cause gluconeogenesis)
  3. Postprandial
  4. Excitement
  5. Renal failure
  6. Pancreatitis
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21
Q

Do cats with Hageman trait have clinical signs of bleeding?

A

NO - clot formation is not dependent on Factor XII, and Hageman trait is a deficiency of factor XII

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22
Q

Do dogs with vWF disease present with petechiation?

A

Usually NO

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23
Q

Do platelet-bound antibody tests differentiate between primary and secondary ITP?

A

NO

Have to rule out causes of secondary ITP to diagnose primary

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24
Q

Echinocytes may be seen with what ddx?

A

Renal failure, lymphoma, rattle snake bites

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25
Q

Eosinophilia is most commonly associated with what?

A

Parasitism (Flea allergy dermatitis, other parasites) or neoplasia (eosinophilic leukemia, mast cell degranulation)

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26
Q

Glucosuria ddx

A
  1. DM
  2. Transient (stress, post-prandial)
  3. Nephrotic syndrome
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27
Q

Hemoglobin is broken down into what two products?

A

Iron and biliverdin

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28
Q

Hemophilia A is a disorder of what clotting factor?

A

VIII

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29
Q

Hemophilia B is a disorder of what clotting factor?

A

IX

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30
Q

Hepcidin expression is increased in response to __ and __ and decreased in response to __ and __.

A

Increased in response to inflammation, iron overload

Decreased in response to hypoxia, anemia

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31
Q

Heritability of hemophilia A and B?

A

autosomal, x-linked, recessive

males are typically affected while females are typically carriers

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32
Q

How are factors II, VII, IX, and X activated and what molecule is required for their activation?

A

Carboxylation, requires vit. K

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33
Q

How does DDAVP (desmopressin) help with vWF disease?

A

DDAVP (desmopressin) - enhances release of vWF from storage sites

Disadvantages: only administer once daily due to potential for water retention and hyponatremia; has short duration of action

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34
Q

How does vincristine help with ITP?

A

Promotes megakaryocyte release from the bone marrow

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35
Q

How is type 2 vWF disease diagnosed?

A

Qualitative ELISA that measures binding of vWF to collagen, which is dependent on high MW multimers

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36
Q

How long after exposure would a coagulopathy happen if an animal ingests anticoagulant rodenticide?

A

2-5 days

PT prolonged w/in 36-72h
aPTT prolonged after PT prolongation

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37
Q

How long does it take the body to start compensating for:
1. An acute respiratory disorder?
2. A chronic respiratory disorder?
3. Very chronic (>30d) respiratory acidosis?
4. Metabolic disorders?

A
  1. 15 minutes
  2. 7 days
  3. 30 days
  4. 24 hours
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38
Q

How long does it typically take for a regenerative RBC response?

A

3-5 days

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39
Q

How much of the function iron pool is stored in hemoglobin?

A

> 60% of total body iron

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40
Q

How much total body iron is typically bound to transferrin at one time?

A

<1%

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41
Q

Hypercholesterolemia ddx

A

Primary - post-prandial
Secondary - Hypothyroidism, Cushings, DM, pancreatitis, nephrotic syndrome, cholestasis

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42
Q

Hyperkalemia in DM results from what mechanism?

A

Translocation of potassium from the ICF to ECF

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43
Q

Hypernatremia can be divided into what three large categories for ddx?

A

Water defecit vs. water loss>Na loss vs. Na gain

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44
Q

Hypoalbuminemia with hyperglobulinemia is seen commonly with what two conditions

A

Chronic liver disease and multiple myeloma

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45
Q

Hypoalbuminemia with hypoglobulinemia is seen commonly with what three things?

A

PLE, exudates, and hemorrhage

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46
Q

If platelets are below __ we can see spontaneous bleeding

A

30-35k

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47
Q

Important growth inducer for hematopoiesis

A

IL-3

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48
Q

In anemia of inflammatory disease, what pattern of ferritin and transferrin would you see on an iron panel?

A

Ferritin = high-normal to increased
Transferrin = low-normal to low

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49
Q

In iron deficiency anemia, what pattern of ferritin and transferrin would you see on an iron panel?

A

Ferritin = decreased
Transferrin = high-normal to increased

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50
Q

In which types of vWF disease is prophylactic therapy indicated?

A

Type 2 and 3

Type 1 have variable bleeding tendency so consider tx on a case by case basis

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51
Q

Increased folate is associated with what conditions

A
  • Intestinal bacterial overgrowth (EPI< decreased gastric acid)
  • Low intestinal pH
  • Parenteral supplementation
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52
Q

Iron enters the duodenal enterocytes via what transporter?

A

DMT1

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53
Q

Is EPO production altered in relative polycythemia?

A

No - this is just a fluid imbalance

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54
Q

Is ferritin a positive or negative acute phase protein?

A

Positive - will increase when inflammation happens

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55
Q

Is PTT normal or prolonged in Hageman trait?

A

Prolonged

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56
Q

Is PTT, PT, or both prolonged in hemophilia patients?

A

PTT is prolonged, PT will be normal

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57
Q

Is transferrin measured directly or indirectly?

A

Indirectly - reported as total iron binding capacity (TIBC). FOUND ON IRON PANELS

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58
Q

Ketonuria ddx

A
  1. DM
  2. starvation
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59
Q

Lipemia ddx

A
  1. Post-prandial
  2. Hypothyroidism
  3. DM
  4. Pancreatitis
  5. Cholestatic liver disease
  6. Nephrotic syndrome
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60
Q

Macrocytosis

A

RBCs that are larger than normal –> increased MCV

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61
Q

Malnutrition, intestinal malabsorption, and EPI lead to hypoalbuminemia by what mechanism

A

Amino acid deficiency

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62
Q

Metabolic acidosis is characterized by what

A

low pH, low HCO3-, low CO2 (resp compensation)

AG can be:
1. High - results from accumulation of excess anions via gain of an acid
2. Normal - results from loss of bicarbonate or retention of H+ with associated hyperchloremia

This is the most common acid-base disturbance in small animal medicine

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63
Q

Metabolic alkalosis is characterized by

A

increased pH, increased HCO3-, increased CO2 (compensatory)

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64
Q

Microcytosis can be seen commonly with what two main disease processes?

A

Iron deficiency and PSS

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65
Q

microcytosis

A

RBCs that are smaller than normal –> decreased MCV

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66
Q

Most common cause of non-regenerative anemia?

A

Anemia of inflammatory disease (aka anemia of chronic disease but doesn’t have to be chronic)

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67
Q

PLN is characterized by what protein changes?

A

Hypoalbuminemia with normal globulins

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68
Q

Primary polycythemia/polycythemia vera

A

Acquired myeloproliferative disorder leading to clonal expansion of single hematopoietic stem cell

RBC production proceeds w/out regard for EPO level

Expected to have LOW plasma EPO due to negative feedback mechanism –> assay is human, no reference ranges in animals but if 0 helps confirm diagnosis

Typically diagnosed by: Erythrocytosis in presence of normal O2 saturation and in the absence of conditions know to be associated with polycythemia

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69
Q

Quantitative ELISA testing for vWF concentration can detect what two types of vWF disease?

A

Type 1 and 3 because the vWF in these types is low

Will not detect type 2

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70
Q

Respiratory acidosis is characterized by

A

decreased pH, increased CO2, increased HCO3-

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71
Q

Respiratory alkalosis is characterized by

A

high pH, low CO2, low HCO3- (compensatory)

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72
Q

Schistocytes may be seen with what disease processes

A

DIC, hemangiosarcoma, uremic syndromes, glomerulonephritis, heart failure, burns, microangiopathic hemolytic anemia

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73
Q

Should you administer vit K if anticoagulant rodenticide ingestion is suspected but not confirmed?

A

NO - a one time prophylactic vit K injection may cause transient normalization of PT at 36-48h but clinical bleeding days later when the effect wears off after a single injection

Instead, test PT at 36-48h post suspected ingestion and treat accordingly

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74
Q

Spherocytes are pathopneumonic with what condition?

A

IMHA

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75
Q

T/F: A polycythemic animal warrants bone marrow aspiration to aid in the differentiation of primary from secondary polycythemia.

A

False - bone marrow evaluation cannot distinguish primary from secondary polycythemia. In either case, erythroid hyperplasia with complete maturation is present.

76
Q

T/F: Appropriate secondary polycythemia results from hypoxemia

A

True - think things like congenital heart defects with R-to-L shunting, chronic pulmonary dz (VQ mismatch), chronic upper airway obstruction (usually brachycephalics), high altitude (clinically silent), defective O2 carrying capacity of Hb (CO poisoning, congenital methemoglobinemia)

77
Q

T/F: FIP results in a monoclonal gammopathy

A

False - polyclonal

78
Q

Three major mechanisms for hypokalemia

A
  1. Decreased intake - unlikely by itself, usually from giving IV fluids without K+ supplementation
  2. ECF into ICF - hyperkalemic periodic paralysis in horses
  3. Increased loss - vomiting/diarrhea, CRF, post-obstructive diuresis, diuretics
79
Q

Total iron binding capacity is __ in anemia of inflammatory disease and __ in true iron deficiency anemia

A

Low-normal in anemia of inflammatory disease; normal in iron deficiency anemia

80
Q

Treatment of anticoagulant rodenticide toxicity?

A

ALL OF THIS IS IF INGESTION IS CONFIRMED
Decontamination - emesis + activated charcoal

-If follow up is high: Base line PT 36-48h after ingestion, if prolonged start Vit K therapy for 2-4 weeks and measure PT 36-48h after discontinuing

  • If follow up is low: start Vit K, if able measure 36-48h after discontinuing vit K

If signs of clinical bleeding: give plasma to restore clotting factors (doesn’t need to be fresh frozen); blood transfusion if clinical anemia; vit K

81
Q

True or false: iron cannot be actively excreted so iron concentration is regulated at the level of absorption

A

TRUE

82
Q

True or false: serum ferritin correlates well with tissue iron stores

A

True - however, because it is a positive acute phase protein, it can also be increased in inflammatory disease

83
Q

True or false: transferrin is a negative acute phase protein

A

True - when inflammation occurs, transferrin production decreases

84
Q

True/false: iron is sequestered in cells in response to systemic inflammation

A

True - the body is motivated to sequester iron so it’s not available to invading pathogens

85
Q

What are ddx for sodium gain leading to hypernatremia

A
  • Hypertonic fluid administration
  • Salt poisoning
86
Q

What are ddx for water deficit leading to hypernatremia?

A
  • Primary hypodipsia
  • DI
  • High environmental temps
  • Fever
87
Q

What are ddx for water loss>Na loss leading to hypernatremia

A
  • Vomiting
  • Diarrhea
  • Peritonitis
  • DM
  • CRF
88
Q

What are side effects of hydroxyurea?

A

Mild: alopecia, nail sloughing, skin lesions
Severe: bone marrow suppression, pulmonary fibrosis

89
Q

What are some BM toxins that could cause a neutropenia?

A

Bracken fern
Estrogen
Anticancer drugs

90
Q

What are the 4 mechanisms of systemic regulation of iron levels?

A
  1. Dietary regulator - uptake by duodenal enterocytes is affected by amount of iron recently consumed
  2. Stores regulator - uptake by duodenal enterocytes is affected by body iron circulation
  3. Erythropoietic regulator - uptake by duodenal enterocytes is increased according to erythropoietic demands
  4. Inflammatory regulator - iron is sequestered in cells in response to systemic inflammation
91
Q

What are the expected compensatory changes in HCO3- for a CAT with respiratory acidosis that is acute, chronic, or very chronic (>30d)

A
  1. Acute: HCO3- increases by 0.15mEq/L
  2. Chronic (up to 30d): unknown
  3. Very chronic (>30d): unknown
92
Q

What are the expected compensatory changes in HCO3- for a CAT with respiratory alkalosis that is acute vs. chronic?

A

Cats
1. Acute: HCO3- INCREASES by 0.25mEq/L
2. Chronic: HCO3- decreases by 0.55mEq/L

93
Q

What are the expected compensatory changes in HCO3- for a DOG with respiratory acidosis that is acute, chronic, or very chronic (>30d)

A
  1. Acute: HCO3- increases by 0.15mEq/L
  2. Chronic (up to 30d): HCO3- increases by 0.35mEq/L
  3. Very chronic (>30d): HCO3- increases by 0.55mEq/L
94
Q

What are the expected compensatory changes in HCO3- for a DOG with respiratory alkalosis that is acute vs. chronic?

A

Dogs:
1. Acute: HCO3- decreases by 0.25mEq/L
2. Chronic: HCO3- decreases by 0.55mEq/L

95
Q

What are the main mechanisms of thrombocytopenia?

A
  1. Decreased production from BM damage (toxic chemicals, drugs, radiation, plant toxins, viruses like distemper or FeLV)
  2. Increased destruction (immune mediated, viruses, drugs such as antihistamines or sulphonamides)
  3. Sequestration in the spleen
  4. Increased consumption - DIC, vasculitis
  5. Loss- bleeding; usually mild to moderate
96
Q

What are the phases of the cell based model of coagulation?

A

Initiation
Amplification
Propagation
Inhibition of coagulation

97
Q

What are the Ps to consider as differentials with a marked neutrophilia with left shift?

A

Pyometra
Peritonitis
Pleuritis
Pneumonia
Pancreatitis
Pyelonephritis
Prostatitis

98
Q

What are the two necessary components of coagulation in the cell based model?

A
  1. A cell bearing tissue factor
  2. Platelets
99
Q

What are the two pathways involved in secondary hemostasis?

A

Intrinsic and extrinsic pathways

100
Q

What are the vitamin K dependent coagulation factors?

A

II, VII, IX, X

101
Q

What are three infectious agents that could cause a neutropenia?

A

Parvovirus
FIV
FeLV

102
Q

What breed can have macrocytosis as a normal finding?

A

Poodles

103
Q

What breeds are associated with platelet dysfunction and what are their associated disorders?

A
  1. Great Pyrenees - Glanzmann thrombasthenia
  2. GSD - platelet procoagulant deficiency (Scott Syndrome)
  3. Basset hound - CALDEG-GEFI thrombopathia
  4. Greater Swiss Mountain Dog - P2Y12 receptor disorder
104
Q

What breeds can have microcytosis as a normal finding?

A

Akitas and Shibas

105
Q

What breeds most commonly have Von Willebrand disease and what types do they get?

A

Dobermans - type 1
German shorthair and wirehair pointers - type 2
Scotties and shelties - type 3

More breeds have been diagnosed but these are most common

106
Q

What changes might you see on an iron panel with iron deficiency anemia?

A

Low ferritin with high-normal to high transferrin

107
Q

What characterizes a metabolic acidosis?

A

Increased H+
Decreased HCO3-

108
Q

What characterizes a metabolic alkalosis?

A

Increased HCO3-
Decreased H+

109
Q

What characterizes a respiratory acidosis?

A

Increased CO2

110
Q

What characterizes a respiratory alkalosis?

A

Decreased CO2

111
Q

What conditions are associated with a Na:K ratio of <25:1

A
  • Addisons
  • Uroabdomen
  • Acute renal failure
  • GI disease (whipworms, Salmonella)
  • Chylothorax
112
Q

What degree of thrombocytopenia would you expect with primary vs. secondary ITP?

A

Primary - severe
Secondary - mild to moderate

113
Q

What diseases are associated with acquired platelet dysfunction?

A

Uremia
Hepatobiliary disease

114
Q

What does an abnormal BMBT indicate?

A

Abnormality of platelet function or Von Willebrand dz

115
Q

What drugs are commonly associated with IMHA?

A

Sulfas
Beta lactams

116
Q

What drugs are most commonly associated with ITP and why?

A

Antibiotics b/c they form haptens (piece of the abx that attaches to cell surface and tags it for immune degredation)

Beta lactams and sulfas most common

117
Q

What enzyme reduces vitamin K after it is oxidized?

A

Vitamin K epoxide reductase

118
Q

What erythrocyte parasites in dogs and cats are associated with a regenerative anemia?

A

Cytauxzoon felis (cats)
Babesia spp. (dogs)
Mycoplasma spp.

119
Q

What form of iron is primarily stored in the cytoplasm of Kupffer cells?

A

Hemosiderin

120
Q

What happens during the amplification phase of the cell-based coagulation model?

A

Thrombin that was generated during the initiation phase activates platelets, releases vWF, and generates active factors V, VIII, and XI. Calcium may induce clustering of phosphatidyl serine on the platelet surface and facilitate binding of coagulation factors, thereby promoting clot formation.

121
Q

What happens during the inhibition of coagulation phase of the cell-based coagulation model?

A

Factor Xa that dissociates from the procoagulant cell membrane is inactivated by AT or TFPI

122
Q

What happens during the initiation phase of the cell-based coagulation model?

A

Flowing blood contacts exposed TF on damaged cells –> generates factor IXa and thrombin on the surface of the damaged cell. Thrombin and factor IXa then diffuse away from the cell surface.

123
Q

What happens during the propagation phase of the cell-based coagulation model?

A

Factors II, V, VIII, IX, X, and XI generated in earlier steps on procoagulant surface assemble into intrinsic tenase. THis causes factor Xa to form on the platelet surface, leading to thrombin generation directly on the platelet. Thrombin then cleaves fibrinogen to fibrinopeptide A - when this occurs rapidly enough to outstrip antithrombin activity, an insoluble fibrin matrix forms

124
Q

What is a strong ion and the strong ion gap?

A

Strong ion = ions that fully dissociate at physiolgic pH

Strong ion gap = difference between all measured plasma strong cations and strong anions

May be more sensitive for animals with multiple disorders affecting acid-base status.

125
Q

What is Hageman trait?

A

Factor XII deficiency - most common deficiency of the intrinsic pathway in cats

126
Q

What is normal pH range?

A

7.43-7.34

127
Q

What is normal range for CO2?

A

25-35mmHg

<25mmHg –> hyperventilation –> resp alkalosis
>35mmHg –> hypoventilation –> resp acidosis

128
Q

What is normal range for HCO3-?

A

19-23mEq/L (dogs); 17-21mEq/L (cats)

129
Q

What is the anion gap?

A

Difference between all measured cations and anions in plasma. More cations can be measured than anions, so AG quantifies the unmeasured anions in plasma.

Cations: Na+, K+, Mg2+, CA2+
Anions: Cl-, HCO3-, albumin, organic acids, phosphate, sulfate

130
Q

What is the blood product of choice for vWF disease dogs during acute bleeding or as surgical prophylaxis?

A

Cryoprecipitate - contains more vWF in less volume

Disadvantages: Short half-life (may need to give every 8-12h for severe bleeding)

131
Q

What is the definition of erythrocytosis?

A

Increase in concentration of erythrocytes –> takes into account elevated PCV resulting from decreased fluid volume, so technically is a more precise term

132
Q

What is the definition of polycythemia?

A

Increase in the total volume of RBCs or red cell mass

133
Q

What is the end goal of primary hemostasis?

A

Platelet plug formation

134
Q

What is the equation for calculating anion gap?

A

AG = (Na + K) - (Cl - HCO3)

Normal dog: 12-24
Normal cat: 13-37

135
Q

What is the expected change in PCO2 for 1mEq/L decrease in HCO3- in a dog or cat with a metabolic alkalosis with respiratory compensation?

A

PCO2 increases by 0.7mmHg –> same for both dogs and cats

136
Q

What is the expected change in PCO2 for 1mEq/L decrease in HCO3- in a dog vs. cat with a metabolic acidosis with respiratory compensation?

A

Dog: PCO2 decreases by 1.0mmHg
Cat: Does not compensate

137
Q

What is the formula for strong ion gap in dogs and cats?

A

Dog SIG = (Alb) x 4.9 - AG
Cat SIG = (Alb) x 7.4 - AG

Normal value in dogs and cats: -5 to +5 mEq/L

138
Q

What is the mechanism of erythrocytosis in a fear/excitement response and what is its duration?

A

Splenic contraction, transient response (20-30 mins)

139
Q

What is the MOA of hydroxyurea?

A

Interferes with DNA synthesis via inhibition of thymidine incorporation

140
Q

What is the most common cause of relative polycythemia?

A

Dehydration (vomiting, diarrhea, PU/PD without adequate intake, splenic contraction)

141
Q

What is the most common hematologic change associated with hydroxyurea?

A

Macrocytosis

142
Q

What is the most common type of FeLV- associated anemia?

A

Pure red cell aplasia

143
Q

What is the most important initiator of coagulation in the cell based model?

A

Tissue factor

144
Q

What is the most important molecule in regulating iron homeostasis?

A

Hepcidin
1. binds ferroportin and triggers internalization of ferroportin
- inhibits export from duodenal enterocytes
- prevents export from other cells for use in physiologic processes
2. Inhibits DMT1 expression

145
Q

What is the other common name for factor II?

A

prothrombin

146
Q

What is the pathophysiology of hemophilia A and B?

A

Lack of factor VIII or IX inhibits formation of tenase complex –> inhibits thrombin generation –> prevents clot formation

147
Q

What is the soluble form of iron and where is it stored primarily?

A

Ferritin, primarily stored in cytoplasm of hepatocytes

148
Q

What is the treatment for primary polycythemia (or secondary polycythemia where the underlying cause cannot be resolved)?

A
  1. Phlebotomy
  2. Myelosuppressive therapy with hydroxyurea
149
Q

What is the typical lifespan of RBCs?

A

100-120 days

150
Q

What is type 1 vWF disease?

A

Low levels of plasma vWF but all multimers are present (they’re all just low) –> mild to moderate bleeding b/c we just don’t have enough of it but have all varieties

151
Q

What is type 2 vWF disease?

A

variable levels of vWF, large multimers are absent

Large multimers bind more strongly to collagen, so these dogs don’t clot as well –> moderate to severe bleeding

152
Q

What is type 3 vWF disease?

A

vWF is absent (all multimers absent) –> severe bleeding

153
Q

What liver enzymes are cholestatic/inducible enzymes?

A

ALP and GGT

154
Q

What liver enzymes are hepatocellular leakage enzymes?

A

ALT, AST, SDH, GLDH, LDH

155
Q

What molecule binds and transports iron in blood?

A

Transferrin

156
Q

What molecule does iron bind to when stored in the cell?

A

Ferritin (apoferritin is ferritin that is not bound to iron)

157
Q

What pattern of hyperglobulinemia would you expect to see with acute inflammation?

A

Alpha and beta, but not gamma globulins

158
Q

What pattern of hyperglobulinemia would you expect to see with chronic inflammation?

A

Elevated alpha, beta, and gamma globulins

159
Q

What pattern of hyperglobulinemia would you expect to see with multiple myeloma?

A

Elevated gamma globulins –> monoclonal gammopathy

160
Q

What receptor mediates iron uptake into cells?

A

Transferrin receptor 1 (TFR1) - expressed on any cells that are rapidly dividing because they have high iron requirements

161
Q

What regulates iron absorption in the GIT?

A

Apoferritin saturation

162
Q

What substances are associated with oxidant-mediated hemolytic anemia?

A

Alliums (onions, garlic), zinc (dogs), skunk musk (dogs), acetaminophen (cats)

163
Q

What system removes RBCs when tagged for degradation

A

Monocyte-macrophage system

164
Q

What transports iron across the basement membrane into plasma?

A

Ferroportin

165
Q

What two breeds are associated with canine cyclic neutropenia?

A

Weimaraners and border collies

166
Q

What two types of neoplasia are commonly associated with IMT?

A

Lymphomas (typically indolent forms)
Histiocytic sarcoma

167
Q

What vit. K dependent clotting factor has teh shortest half life?

A

Factor VII

168
Q

When should you suspect a platelet dysfunction disorder in an animal?

A

When they have normal platelet count, normal coagulation times, and in which vWF disease has been ruled out

These are UNCOMMON in animals

169
Q

Where are the vit. K dependent clotting factors produced?

A

Liver

170
Q

Will BMBT be normal or prolonged in dogs with platelet function disorders?

A

Prolonged

PFA-100 (platelet analyzer) will be abnormal

171
Q

Increased EPO production in response to hypoxia is induced by what?

A

HIF-1 binding hypoxia-response element on EPO gene, which leads to increased transcription of the EPO gene —> increased EPO production

172
Q

What other clin path parameters can influence accuracy of Hct or PCV measurements and how?

A

Lipemia, icterus: no effect.
Hemolysis (sample collection or storage)
Insufficient centrifugation speed: falsely increase PCV (RBCs don’t pack properly)

173
Q

Cytology of normal joints - what cells?

A

Occasional MN small & large Lc/phagocytes

174
Q

What is the association between PCV and point of care blood glucose?

A

Inverse relation (lower HCT –> high BG & vice versa).
Correction formula available.

175
Q

What is the association between PCV & POC blood glucose measurements?

A

Inverse relation (lower HCT –> high BG & vice versa).
Correction formula available.

176
Q

2yo MN Lab, recent travel to Arizona. FNA of scapular mass. Diagnosis?

A

Coccidioiodomycosis immitis osteomyelitis

177
Q

3yo MN X breed dog. FNA of carpal mass. Diagnosis?

A

Blastomycosis dermatitidis

178
Q

FNA of lytic bone lesion. 4yo MN dog. Diagnosis?

A

Histoplasma capsulatum
(small, intra/extracellular, within Mp)

179
Q

2yo FS GSD. FNA of lytic vertebral lesion. Diagnosis?

A

Aspergillus sp. (terrus/fumigatus most common)

180
Q

3yo MN dog. FNA of spleen. Diagnosis & treatment options?

A

Leishmaniasis (infantum/donovani)
Allopurinol monotx OR
Combo allopurinol + meglumine antimionate if not azotemic (preferred)
Combo allopurinol + miltefosine = alternative
Tx proteinuria if significant

181
Q

What 2 parameters can falsely increase USG?

A

Marked glucosuria (e.g. hyperosmolar hyperglycemic syndrome)
Marked proteinuria
USG increases by 0.005 per 1g/dL of glucose/protein in urine

182
Q

Cytological diagnosis? List the types of disease, mode of inheritance & breeds that are associated with this condition?

A

Cystinuria. Inherited defect in proximal tubule COLA AA transporter. Mutations in SLC3A1 (encodes heavy chain) or SLC7A9 (encodes light chain).

Type Ia – autosomal recessive. SLC3A1. Newfies, Labs, Landseers.

Type IIa - autosomal dominant with incomplete penetrance. SLC3A1. ACD, Border Collies

Type IIb - SLC7A9. Mini Pins
Type III - sex linked, androgen dependent. Intact males. Mastiffs, English & French bulldogs

183
Q

In which 2 breeds may this be a normal finding?

A

Ammonium biurate (thorny apple shape)
Dalmatians & Eng Bulldogs.

184
Q

Cytological diagnosis? What condition is this classic for? What other ddx?

A

Calcium oxalate MONOhydrate (dihydrate = X shaped)

Ethyelen glycol toxicity (but not sensitive finding; less commonly see CaOx dihydrate)
DDx other dz causing hypercalciuria (eg paraneoplastic LSA)

185
Q

FNA of bladder trigone mass from 8yo MN dog. Cytological diagnosis? And what are the pink cytoplasmic vacuoles called?

A

Urothelial cell carcinoma
Melamed–Wolinska bodies (unique feature of TCC)

186
Q

FNA of renal mass from 1yo dog. 2 main ddx? What IHC stains can differentiate?

A

Renal LSA (cats usually B cell; granules may suggest T cell or granular LSA)
Nephroblastoma (YOUNG animals)
- Arises from embryonic metanephric blastema.
- IHC: cytokeratin+ (epithelial), vimentin+ (mesenchymal). Wilm’s tumor gene product + confirms dx.

187
Q

What are the lower detection limits of the urine dipstick & SSA test?

A

Urine dipstick = 30mg/dl (below that = microalbuminuria)
SSA test = 5mg/dl (can detect globulins + BJ proteins)

ACVIM SAIM (2023) (19 decks)

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