Exam 1

Question 1

Low TP, Low PCV

Answer 1

Substantial ongoing or recent blood loss

Over-hydration

Question 2

Low TP, Normal PCV

Answer 2

GI protein loss
Proteinuria
Liver disease

Question 3

Low TP, High PCV

Answer 3

Protein loss combined with relative or absolute erythrocytosis

Question 4

Normal TP, Low PCV

Answer 4

Increased erythrocytes destruction
Decreased erythrocyte production
Chronic hemorrhage

Question 5

Normal TP, High PCV

Answer 5

Splenic contraction
Absolute erythrocytosis
Dehydration masked hypoproteinemia

Question 6

High TP, Low PCV

Answer 6

Anemia of inflammatory disease

Multiple myeloma or other lymphoproliferative disease

Question 7

High TP, Normal PCV

Answer 7

Increased globulin synthesis

Dehydration masked anemia

Question 8

High TP, High PCV

Answer 8

Dehydration

Question 9

What clinical findings differentiate intravascular and extravascular hemorrhage?

Answer 9

Intravascular: hemoglobinemia, hemoglobinura

Both have bilirubinemia, bilirubinuria, icterus

Question 10

What RBC morphology accompanies extravascular hemolytic anemia?

Answer 10

Spherocyte = immune/other causes, erythrocytes coated with antibody

Question 11

What RBC morphology accompanies intravascular hemolytic anemia?

Answer 11

Ghosts = immune-mediated attack, Hgb leaks out

Question 12

What does the presence of Heinz Bodies indicate?

Answer 12

Oxidative damage

Question 13

IMHA lab findings

Answer 13

Regenerative anemia
Agglutination
Spherocytosis (no central parlor)
Neutrophilia
Pigmenturia/emia - bilirubinuria, bilirubinemia, icterus (NOT HEMOGLOBINEMIA/URIA BC IMHA IS EXTRAVASCULAR)
Variable platelets
Abnormal liver enzymes

Question 14

RBC changes seen with oxidative damage

Answer 14

Heinz bodies
Eccentrocytes, pyknosis
Methemoglobin - can’t carry O2

Question 15

Lab findings for hemolytic anemia caused by oxidative damage

Answer 15

Regenerative anemia = polychromasia
Heinz bodies (NMB stain)
Eccentrocytes, pyknocytes
Methemoglobinemia on spot test filter 
Hgb crystals

Question 16

Diagnostic tests for IMHA

Answer 16

Saline test (agglutination)
Coomb's test - when agglutination is absent, detects immune system proteins on RBC, but doesn't distinguish cause

Question 17

Regenerative Anemias

Answer 17

Hemorrhage - external, internal, chronic, acute

Hemolysis - extravascular, intravascular, acquired, congenital, IMHA, oxidative damage

Question 18

Common non-regenerative anemia lab findings

Answer 18

Normocytic, normochromic anemia (mild to moderate)
Non-regenerative - no polychromasia
Other cells lines affected with intramarrow disease - leukopenia, thrombocytopenia

Question 19

Conditions that depress intramarrow activity, seen with non-regenerative anemia

Answer 19

Chronic renal failure - inadequate EPO production, also serum biochem changes consistent with renal disease
Chronic inflammation/infection
Chronic liver disease - inadequate iron delivery/decreased RBC lifespan, also see decreased MCV/MCHC, acanthocytes

Question 20

Lab findings with iron-deficiency anemia

Answer 20

Microcytic, hypochromic/normochromic anemia
Fragmentation: schistocytes, keratocytes, acanthocytes
THROMBOCYTOSIS
Panhypoproteinemia
Early polychromasia, then diminished

Question 21

Two classic signs of lead toxicity

Answer 21

Metarubricytosis

Basophilic stippling

Question 22

Lab findings with relative erythrocytosis, common causes

Answer 22

Increased PCV, TP

Dehydration, edema

Question 23

Lab findings with transient erythrocytosis, cause

Answer 23

Increased PCV, normal TP

Splenic contraction

Question 24

Lab findings with absolute erythrocytosis; primary vs secondary

Answer 24

Increased PCV, normal TP
Primary - decreased PaO2, neoplasticism RBC growth, sludgy blood unable to carry O2
Secondary - normal PaO2, increased EPO production

Question 25

Hemostasis

Answer 25

Interaction of blood vessels, platelets and coagulation factors to stop hemorrhage without obstructing blood flow - balance between fibrin clot formation and degradation

Question 26

4 proteins that inhibit coagulation or regulate fibrinolysis

Answer 26

Plans in Antithrombin 3 Protein C with protein S Tissue factor pathway inhibitor (TFPI)

Question 27

Is plasma or serum used for coagulation testing, why?

Answer 27

Plasma = fluid that remains if blood is prevented from clotting (citrate preferred) Serum - lacks fibrinogen, factor 5 and 8 (consumed during clot formation)

Question 28

PT

Answer 28

Prothrombin time - measure of extrinsic and common pathway Measures time for fibrin clot to form - 70% deficiency before prolonged - inhibition/deficiency of factor 7 or common pathway - 7 = shortest half-life, first one to be affected in Vitamin K antagonism/deficiency

Question 29

PTT

Answer 29

Partial thromboplastin time - measure of intrinsic and common pathway Measures time for fibrin clot to form - 70% deficiency before prolonged - inhibition/deficiency of intrinsic or common pathway - Factor 12 deficiency doesn't cause bleeding in some species Can be artificially prolonged by warm/delayed sample, low plasma:citrate

Question 30

ACT

Answer 30

Activated clotting/coagulation time - measure of intrinsic and common pathway Measures time for fibrin clot to form (uses patients own Ca2+) - 95% deficiency before prolonged - severe thrombocytopenia can cause slight prolongation

Question 31

Significance of FDP/FSPs

Answer 31

Increased concentration inhibits coagulation, promotes bleeding

Question 32

Increased fibrinogenolysis

Answer 32

Only increases FDPs

Question 33

How are D-dimers formed and how can they be detected?

Answer 33

Plasmin degradation of CROSS-LINKED fibrin = more specific than FDPs D-dimer test or TEG DIC***

Question 34

Fibrinogen estimate

Answer 34

Better at detecting decreases than increases Increase = inflammation (especially LA) Decrease = DIC

Question 35

What is DIC? What are the two phases? Potential causes?

Answer 35

``` Uncontrolled, continued activation of coagulation and fibrinolysis Hypercoagulable phase (thrombosis) followed by consumptive phase (platelet/coagulation bleeding) Hypercoagulable states: inflammatory diseases, heat stroke, HW ```

Question 36

Classic lab findings with DIC

Answer 36

Anemia Thrombocytopenia (mild to mod) Fragmentation morphology = acanthocytes, schistocytes May also have prolonged clotting tests, or faster if phase 1 Increased FDPs

Question 37

What are two other major coagulation abnormalities (acquired) other than DIC?

Answer 37

Liver disease - liver is where coagulation factors are made | Vitamin K deficiency/antagonism - affects 2, 7 , 9, 10 = PT decreases first then PTT, ACT (rodenticide toxicity)

Question 38

What is the major congenital coagulopathy?

Answer 38

vW disease - vWF important for platelet adhesion and aggregation = primary hemostasis Factor 8 = major carrier of vWF

Question 39

Lab findings for vW disease

Answer 39

Bleeding, cutaneous bruising, hemorrhage Prolonged BMBT* Normal platelet count Normal PT, PTT (PTT prolonged in horses)

Question 40

Primary vs secondary hemostasis, tests

Answer 40

``` Primary = platelets (BMBT - only if platelet number normal/elevated - platelet function) Secondary = coagulation, fibrin plug (PT, PTT, ACT) ```