Haematology (1-4) Flashcards
(115 cards)
1
Q
what 6 values must you have in order to evaluate anaemia
A
- total RBC count
- haemoglobin concentration (Hb)
- Packed cell volume (PCV)
- Corpuscular values (MCV & MCHC)
- Reticulocyte count
- serum total protein (TP)
2
Q
what are the 2 erythrocyte indices
A
- mean cell volume (MCV)
- Mean corpuscular haemoglobin concentration (MCHC)
3
Q
name 3 causes or routes for external blood loss
A
- trauma
- GI bleeding
- urinary tract
4
Q
name 3 common sources of intra-cavity bleeding
A
- splenic/hepatic HSA
- pleural haemorrhage
- intra-pulmonary hemorrhage
5
Q
name 6 clinical signs of haemorrhage/blood loss anaemia
A
- weakness
- shock
- poor peripheral pulses
- tachycardia, tachypnoea
- pale mucus membranes
- underlying disease (abd. distension, incr. resp noise)
6
Q
how long does it take for a regenerative response to haemorrhage/blood loss anaemia to begin (how long does it take for bone marrow to respond)
A
3-5 days
7
Q
name the two types of haemolytic anaemia
A
- immune-mediated
- non-immune-mediated
8
Q
name 5 examples of non-immune-mediated haemolytic anaemia
A
- oxidative injury
- heinz body anaemia
- erythrocte enzymopathies
- incr. erythrocyte fragility
- microangiopathic anaemia
9
Q
name 4 possible causes of secondary IMHA (immune-mediated haemolytic anaemia)
A
- infectious
- inflammatory
- drug-induced
- neoplasia
10
Q
name 3 drugs which may induce secondary IMHA
A
- sulphonamides
- penicillins
- methimazole
11
Q
name 4 possible inflammatory causes of secondary IMHA
A
- pancreatitis
- pyothorax
- pyometra
- dental infection
12
Q
name 4 signs of IMHA that can be seen on a blood smear
A
- nucleated RBC
- polychromasia
- anisocytosis
- spherocytosis
13
Q
name 2 tests that can be used to identify IMHA
A
- saline agglutination test
- Coomb’s test
14
Q
what to 4 signs look for on haematology for suspected IMHA
A
- reticulocytosis (3-5 days)
- leucocytosis (dogs only)
- neutrophilia +/- left shift
- thrombocytopenia
15
Q
what 3 signs to look for on serum biochemisry for suspeted IMHA
A
- hyperbilirubinaemia
- hypoalbuminaemia
- evidence of organ dysfunction (incr. ALT & AP)
16
Q
name 3 causes of Feline Infectious Anaemia (FIA)
A
- Mycoplasma haemofelis
- M. haemomintutum + FeLV
- M. turicensis
17
Q
what must be ruled out in order to diagnose primary IMHA
A
Babesiosis
18
Q
how to confirm Babesiosis
(r/o primary IMHA)
A
PCR
19
Q
name 6 immuno-suppressive drug therapies that can be used to manage IMHA
A
- glucocorticoids (all cases)
- azathioprine 1st (not cats)
- ciclosporin 1st (care w cats)
- mycophenolate mofetil 2nd
- chlorambucil
- IV immunoglobulin (IVIG)
20
Q
these are nuclear remnants that can be seen in RBCs
differential diagnosis for haemoplasmas seen with Feline Infectious Anaemia
A
Howell-Jolly bodies
21
Q
these are oxidized precipitated haemoglobin that can be seen with oxidative injury causing haemolytic anaemia
A
Heinz bodies
22
Q
what is denatured haemoglobin called
A
methaemoglobin
(cannot carry oxygen)
23
Q
name 5 causes of oxidative injury +/- Heinz body (Hb) anaemia
A
- paracetamol toxicity
- onion toxicity
- benzocaine
- zinc toxicity
- propofol infusion
24
Q
name 4 consequences of oxidative injury & heinz body formation
A
- haemolytic anaemia
- decr. erythrocyte life-span
- methaemoglobin
- ‘chocolate’ mucus membranes
25
what absolute reticulocyte count indicates a regenerative response
greater than 60 x 10^9 /L
26
what absolute reticulocyte count indicates a strong regenerative response
greater than 500 x10^9 / L
27
name 6 differential diagnoses for non-regenerative anaemia
1. anaemia of inflammatory disease
2. chronic kidney disease
3. haemoglobin synthesis defects
4. nuclear maturation defects
5. pure red cell aplasia
6. bone marrow infiltration
28
# name the Ddx for non-regenerative anaemia
mild to moderate anaemia;
typically normocytic, normochromic BUT may be hypochromic;
inflammatory cytokines TNF-alpha and IL-1
anaemia of inflammatory disease
29
# name the Ddx for non-regenerative anaemia
deficiency of EPO;
'uraemic toxins' (PTH) suppresses haematopoiesis;
decr. RBC life span;
incr. gastrin leads to gastric haemorrhage
chronic kidney disease
30
# name the Ddx for non-regenerative anaemia
decr. Hb resulting in hypochromic;
extra cell divisions resulting in microcytosis;
BUT may be normocytic, normochromic
iron deficiency anaemia
31
# name the Ddx for non-regenerative anaemia
immune-mediated destruction of RBC precursors;
maturation arrest;
30% Coomb's positive
pure red cell aplasia
32
# name the Ddx for non-regenerative anaemia
bone marrow replaced by non-marrow elements (myelofibrosis or neoplastic cells → nRBC, dysplastic or primitive white blood cells)
Myelophthisis/Myelodysplasia
33
# name the Ddx for non-regenerative anaemia
bone marrow replaced by adipocytes due to insult to progenitor cells
aplastic anaemia/pancytopenia
34
what disease will cause a loss of anti-thrombin III
& what can a decrease in anti-thrombin III lead to?
1. protein-losing nephropathy
2. thromboembolism
35
minor bleeds / prolonged bleeding will be seen with dysfunction of what type of haemostasis
primary haemostatic dysfunction
36
large bleeds / re-bleeding will be seen with dysfunction of what type of haemostasis
secondary haemostatic dysfunction
37
how to evaulate primary haemostasis
1. platelet number
2. BMBT (buccal mucosal bleeding time)
38
what 3 things will a BMBT (buccal mucosal bleeding time) tell you
1. platelet function
2. vascular response to injury
3. adequacy of vWF
39
how long should it take for bleeding to cease in BMBT (buccal mucosal bleeding time) test
2-4 min
40
what 3 things should you look at to evaluate secondary haemostasis
1. coagulation cascade
2. fibrinolysis
3. modulators of coagulation
41
what coagulation pathways does Prothrombin Time (PT) evaluate
extrinsic & common pathways
42
what does PIVKA stand for
proteins induced by vitamin K antagonists or absence
43
what 4 clotting factors are affected by PIVKA
1. II (2)
2. VII (7)
3. IX (9)
4. X (10)
44
what coagulation pathway does Thrombin Time (TT) evaluate
common pathway
45
what coagulation pathways does Activated Partial Thromboplastin Time (APTT) evaluate
intrinsic and common pathways
46
this is widespread activation of coagulation & fibrinolytic systems;
widespread thrombosis, multiple organ failure & haemorrhage
Disseminated Intravascular Coagulation (DIC)
47
name 4 hallmarks/signs of combined haemostatic disorders (DIC)
1. thrombocytopenia
2. prolonged PT +/- APTT
3. low fibrinogen
4. schistocytes on blood smear evaluation
48
name 4 causes of primary haemostatic dysfunction
1. thrombocytopenia
2. platelet dysfunction (thrombocytopathia)
3. von Willebrands Disease
4. vasculitis
49
name 3 causes of secondary haemostatic dysfunction
1. inherited coagulopathies
2. rodenticide toxicity
3. liver disease
50
name 6 clinical signs of primary haemostatic dysfunction
1. petechiation & ecchymotic haemorrhages
2. epistaxis
3. GI bleeding
4. gingival bleeding at tooth eruption
5. ocular haemorrhage
6. vasculitis
51
name 5 inherited factor deficiencies that cause dysfunction of secondary haemostasis
1. factor I deficiency (Maine Coons)
2. factor VIII deficiency (haemophilia A)
3. factor IX deficiency (haemophilia B)
4. factor XI deficiency (haemophilia C)
5. factor XII deficiency (Hageman trait)
52
what are the 2 most common causes of acquired coagulation disorders causing dysfunction of secondary haemostasis
1. anticoagulent rodenticide toxicity
2. liver disease
53
what is the treatment for anticoagulant rodenticide toxicity
vitamin K1
54
vitamin K is required for the normal function of which 4 clotting factors
1. II (2)
2. VII (7)
3. IX (9)
4. X (10)
55
what is the most common neoplasia that causes DIC
haemangiosarcoma
56
name 3 most common infectious diseases that can lead to DIC
1. Angiostrogylus vasorum
2. bacterial sepsis
3. leptospirosis
57
name the 3 laboratory hallmarks of DIC
1. thrombocytopenia
2. schistocytes on blood smear
3. prolonged PT +/- APTT
58
# name the lymphoproliferative disease
neoplastic change arises in peripheral lymphoid tissue
lymphoma
59
# name the lymphoproliferative disease
neoplastic change arises in the bone marrow
lymphoid leukaemias
60
# name the lymphoproliferative disease
B-cell tumour, usually functional
myeloma
61
# name the type of canine lymphoma
84% of lymphoma cases in dogs;
marked non-painful lymph node enlargement;
hepatosplenomegaly;
depression (non-specific malaise);
pyrexia;
PU/PD
multicentric lymphoma
62
# name the type of canine lymphoma
younger dogs;
lethargy, exercise intolerance;
respiratory distress;
cough;
weight loss;
regurgitation/dysphagia;
PU/PD
cranial mediastinal lymphoma
63
# name the type of canine lymphoma
middle aged and older dogs;
insidious weight loss;
diarrhea;
malabsorption/PLE;
ocassionally vomiting;
hyporexia
alimentary lymphoma
64
# name the type of canine lymphoma
skin;
primary cutaneous lymphoma OR non-epitheliotrophic lymphoma
extranodal lymphoma
65
how is 90% of lymphoma cases diagnosed
FNA
66
which lymph node should FNA samples be taken from for diagnosis of lymphoma
popliteal node
67
which lymph node should be avoided when taking FNA samples for diagnosis of lymphoma
submandibular node
68
what to look for on a lymph node FNA smear to diagnose lymphoma
(3 things)
1. clumped chromatin, nucleoli
2. basophilic cytoplasm
3. mitoses
| (monomorphic population of large lymphoblasts )
69
can small cell lymphomas be diagnosed cytologically?
no
69
what sort of biopsy can be done of a lymph node to diagnose lymphoma
excisional biopsy of node
70
what sort of biopsy should be avoided to diagnose lymphoma
Trucut needle biopsies
71
# name the diagnostic test
laser based technology;
assesses cell population in fluid;
measure multiple characteristics of cells by light scatter and fluorescence using lasers;
can be used to diagnose lymphoma in cases when biopsy is difficult
flow cytometry
72
# name the diagnostic test
specialised PCR which amplifies either immunoglobulin gene (from B cells) OR T cell receptor gene (from T cells);
assessment of clonality
PARR
(PCR for Antigen Receptor Rearrangements)
73
what classical pattern is occasionally seen on abdominal organs, such as the spleen, with lymphoma
"ocelot's pelt" lesions
(swiss cheese pattern)
74
what lymphoma substage is used for systemically well patients
substage a
75
what lymphoma substage is used for systemically unwell patients
substage b
76
# name the lymphoma stage
single lymph node/lymphoid tissue of a single origin
stage 1
77
# name the lymphoma stage
regional lymph node involvement (+/- tonsils)
stage 2
78
# name the lymphoma stage
generalised lymphadenopathy
stage 3
79
# name the lymphoma stage
involvement of liver and/or spleen (+/- generalised lymphadenopathy)
stage 4
80
# name the lymphoma stage
involvement of blood, BM, other organs
stage 5
81
name 5 poor prognostic indicators for canine lymphoma
1. T cell tumours
2. systemic illness
3. stage 5 disease
4. hypercalcaemia
5. hypoalbuminaemia
82
name 4 treatment options for canine lymphoma
1. none
2. corticosteroids
3. single agent chemotherapy
4. combination chemotherapy (CHOP & COP regimes)
83
name 3 possible toxicities of single agent doxorubicin as treatment for lymphoma
1. Bone marrow
2. Alopecia
3. GI signs
| (BAG)
84
what is a big risk of doxorubicin and epirubicin administration
SEVERE perivascular vesicant
85
# name the chemotherapy agent
30 mg/m^2 IV q21 days;
70% of dogs achieve CR;
median remission time 170 days;
antitumour antibiotic/anthracycline;
multiple mechanism of action;
CCPNS (more active in S phase);
metabolised mainly by liver;
mainly faecal excretion
doxorubicin
86
# name the chemotherapy agent
70 mg/m^2 orally q21 days;
until PD or hepatotoxicity (max 5 cycles);
alkylating agent;
CCPNS;
hepatic metabolism;
urinary excretion;
myelosuppressive (can be severe, delayed and cumulative)
lomustine
87
what 3 drugs are used in the COP chemotherapy regime
1. vincristine
2. cyclophosphamide
3. prednisolone
88
which regime is continuous?
COP or CHOP?
COP
89
# name the chemotherapy agent
plant alkaloid;
inhibition of microtubule formation;
M pjhase specific;
hepatic metabolism;
faecal excretion;
infrequently significantly myelosuppressive;
GI effects rare;
EXTREME perivascular irritant
vincristine
90
# name the chemotherapy agent
alkylating agent (bifunctional);
cell cycle phase non-specific (CCPNS);
prodrug activated by liver;
active metabolites alkylate DNA by substituting alkyl radicals for H atom in DNA;
inhibits DNA and therefore RNA and protein synthesis;
primarily urinary excretion;
metabolite acrolein causes sterile haemorrhagic cystitis
cyclophosphamide
91
name 4 possible toxicities of cyclophosphamide
1. myelosuppression
2. GI effects
3. sterile haemorrhagic cystitis
4. alopecia
92
what 4 drugs are used in the CHOP protocol
1. vincristine
2. prednisolone
3. cyclophosphamide
4. doxorubicin/epirubicin
93
which chemotherapy drug can cause haemorrhagic cystitis
cyclophosphamide
94
# name the chemotherapy agent
pyrimidine analogue;
stops DNA synthesis;
may block progresion from G1 to S;
inhibits DNA repair;
S phase specific;
extensively activated and metabolised;
urinary excretion; myelosuppression;
GI effects;
greater toxicity if given by infusion
cytosine arabinoside
95
# name the chemotherapy agent
plant enzyme - degrades asparagine;
G1 and other phases;
anaphylaxis (do NOT use IV);
pancreatitis
resistance emerges rapidly
L-asparaginase
96
exposure to what virus can greatly increase a cat's risk of lymphoma
FeLV
97
name 5 differential diagnoses for feline multicentric lymphoma
1. infections
2. otehr haemopoietic malignancies
3. immune mediated disease
4. idiopathic forms
5. metastatic disease
98
name 5 differential diagnoses for feline submandibular or cervical lymphoma
1. abscesses
2. reactive nodes
3. metastatic disease
4. mycobacterial infection
5. salivary gland, thyroid and other masses
99
name 3 differential diagnoses for feline cranial mediastinal lymphoma
1. thymoma
2. other cranial mediastinal lymphadenopathy
3. other causes of pleural effusion (congestive heart failure, pyothorax, FIP)
100
name 3 positive prognostic indicators for a cat with lymphoma
1. achieving CR
2. small volume extranodal disease
3. T cell immunophenotype
101
name 3 negative prognostic indicators for a cat with lymphoma
1. failure to achieve CR
2. FeLV +ve status
3. previous therapy with corticosteroids
102
what is the median survival of a cat with lymphoma without therapy
4 weeks
103
what is the best therapy protocol for a cat with lymphoma
COP
104
what is a cat specific consideration for vincristine
mild transient inappetance
105
what is a cat-specific consideration for prednisolone
hyperadrenocorticism
106
name 2 alternatives to cyclophosphamide for cats
1. chlorambucil (only if in remission)
2. melphalan
107
what should multiple myeloma in a cat be treated with
melphalan and prednisolone
108
name 3 negative prognositic indicators for a cat with multiple myeloma
1. proteinuria
2. hypercalcaemia/azotaemia
3. extensive bone lesions
109
# name the type of leukaemia
transformation of stem cells results in failure to differentiate;
rapid proliferation;
arrested/defective maturation;
marrow rapidly becomes overcrowded;
clinical signs sever, course rapid
acute leukaemia
110
# name the type of leukaemia
transformation occurs in the stem cell but differentiation is not blocked;
proliferation not controlled;
effects on normal haemopoiesis less devastating;
clinical signs less severe;
course insidious
chronic leukaemia
111
what causes the clinical signs of leukaemia?
disruption of normal haemopoiesis
112
this is often the first manifestation of failure of haemopoiesis
neutropenia
113
name 5 clinical signs of neutropenia
(often first manifestation of failure of haemopoiesis)
1. reduced host defence against pathogens
2. malaise
3. pyrexia
4. sepsis
5. septic shock
114
name 5 biochemical abnormalities associated with leukaemia
1. azotaemia
2. monoclonal gammopathy
3. hypoproteinaemia
4. hypercalcaemia
5. raised liver enzymes
