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1
Q

Increased bands

A

inflammation

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2
Q

Spherocytes

A

IMHA

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3
Q

Increased reticulocytes

A

> 60,000 moderatley regenerative

>200,000 maximal regeneration

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4
Q

“penia”

A

decreased concentration of cells

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5
Q

“philia” or “cytosis”

A

increased concentration

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6
Q

Left shift

A

increased concentration of immature WBCs in blood

increased bands

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7
Q

2x fold increase in leukocyte concentrations (leukocytosis), no left shift

A

excitement (cats mainly)

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8
Q

Lymohopenia with neutrophilia (2x fold increase of upper limit of neutrophils), no left shift

A

Stress response = low lymphs

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9
Q

Left shift or a neutrophil conc greater than 2x

A

Inflammation

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10
Q

Neutrophilia

A

inflam
excitement
stress

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11
Q

Neutropenia

A

consumption within inflam lesion
immune mediated destruction
lack of production by bone marrow

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12
Q

Lymphopenia

A

steroid response
acute viral infections
immunodeficiency (rare)

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13
Q

Monocytosis

A

inflam

stress response

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14
Q

Eosinophilia

A

parasitism
hypersensitivity
mast cell tumor

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15
Q

Macrocytic anemia

A

regenersation

immature RBCs are bigger than mature

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16
Q

Microcytic anemia

A

Fe def anemia

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17
Q

Echinocytes

A

crenation
electrolyte imbalances
non specific dz (kidney dz)
rattlesnake venom

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18
Q

Acanthocytes

A

cats: hepatic lipidosis
dogs: hemangiosarcoma

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19
Q

Schistocytes

A 
IV trauma (DIC, vascular tumor)
Iron def anemia
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20
Q

Keratocyte

A

iron def anemia

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21
Q

Spherocytes

A

IMHA

normal volume

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22
Q

Eccentrocytes

A

oxidative damage
onions
-often seen with heinz body formation

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23
Q

Heinz body anemia

A 
oxidatively denatured HB
Acetaminophen, propylene glycol (cats)
Onions, garlic
Cephalosporin (dogs)
Zinc toxicosis (pennies)
Wilted red maple leaves (horses)
Kale, onions (cattle)
Copper (sheep)
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24
Q

Basophilic stippling

A

normal in ruminants
regen anemia in dogs/cats
If a significant amount think lead poisoning

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25
nRBCs and Howell Jolly bodies
regenerative anemias non functioning spleen or splenectomy increased corticosteroids lead poisoning
26
Agglutination
IMHA
27
Rouleaux
normal in horses | increased globulin in small animals
28
Platelets and the spleen
1/3 platelet mass is in the spleen | when spleen contracts, increases # in the body circulation
29
What is the order of events in platelet plug formation?
adhesion, activation, aggregation
30
Increased numbers of enlarged platelets suggests
active platelet production ***check blood smears for platelet clumping, don't rely on machine***
31
Patients are at risk for spontaneous hemorrhage when the platelet count is
<30,000uL | patients with immune mediated thrombocytopenia ITP
32
What three things suggest PLT regeneration?
macroplatelets on blood smear increased MPV increased megakaryocyte #s (BMA: bone marrow aspirate)
33
Bleeding tests are abnormal when
decreased platelet function and/or decreased platelet numbers
34
Mechanisms of thrombocytopenia
``` (PDSLC) production destruction sequestration loss consumption ```
35
The degree of thrombocytopenia depends on the extent of
bone marrow dz
36
T/F Hemorrhage alone can cause significant thrombocytopenia
FALSE | thrombocytopenia causes hemorrhage
37
3yr SF cocker spaniel presents lethargic, weak, tachycardic, with pale mm and petechiation: PCV Low 15% TP norm PLT Low-severe
``` DIC (consumption) Multiple myeloma (decrease production) Immune mediated thrombocytopenia (destruction) ```
38
On a blood smear, macrothrombocytisis is seen. On the hematology analyzer, this finding correlates with what type of reading?
increased MPV (mean platelet volume)
39
What dx test is commonly used to assess platelet function?
buccal mucosal bleeding time
40
von Willebrand DIsease (vWD) is a decrease in
platelet adhesion platelets are usually normal platelets float away, platelet plug not formed
41
``` Why are the plateletes increased in the bloodwork from the following adult dog? PCV low MCV (mean corpuscular vol) low PLT high MPV (mean platelet vol) high 10% macroplatelets ```
MCV low so microcytic PCV low so anemia MPV high so actively being produced IRON DEF ANEMIA
42
Blue vs red microhematocrit tubes
red is heparinized | blue isn't
43
PCV is the % whole blood composed of
erythrocytes
44
5 solutes that interfere with artificially increased TP:
``` CHUGL Cholesterol Hemolysis Urea Glucose Lipemia ```
45
If the PCV and TP are proportionally increased, the the patient is ____
dehydrated
46
If the PCV and TP are proportionally decreased, then the patient ____
has blood loss
47
Red or pink plasma indicates:
intravascular hemolysis
48
With severely low PCV, it must be ____ if the P walks thru the door
gradual onset/chronic (lack of production) if acute, then animal probably can't walk (blood loss/ destruction)
49
CS of anemia
``` pale mm lethargy increased respiration, dyspnea increased HR murmurs ```
50
Acute blood loss shows a decrease in ___ as well as decreased PCV
protein
51
Examples of chronic blood loss
``` Iron def anemia GI bleeding Bleeding GI tumor Parasites *loss via intestine most common* ```
52
Iron def in adults is almost always due to
CHRONIC BLOOD LOSS
53
Dx of iron def anemia
anemia low serum iron microcytosis RBC have increased central pallor
54
``` 10 yr MC yellow lab 4 episodes of weakness PCV 16% low RBC low Hgb low Retics high TP dropped since last visit Segs high Bands high nRBCs high PLT low Acanthocytes, schistocytes ```
``` low PCV=anemia high retics = regeneration TP drop = blood loss high segs = inflam high nRBCs = regnerative PLT low = thrombocytopenic blood loss ``` found mass on liver & spleen, prob hemangiosarcoma
55
``` Low PCV Low Retics Low MCV Increased bands Triple segs keratocytes, schistocytes, blister cells, giant platelets ```
``` Low PCV = severe anemia Low retics = non regenerative microcytic = chronic blood loss Increased bands and triple segs = inflam Decreased MCV, RBC morphology = Fe def anemia ```
56
``` 17 yr old cat lethargy, enlarged abdomen PCV low MCV low Bands high Lymphs low Keratocytes on blood smear ```
``` PCV low= anemia MCV low= microcytosis Bands high= inflam Lymphs low= stress Keratocytes= Fe def ``` Iron def anemia
57
Examples of blood destruction
IMHA Heinz body anemia RBC parasites
58
Signs of blood destruction
``` anemia splenomegaly hyperbilirubinemia, icterus hemoglobinemia hemoglobinuria norm TP ```
59
IMHA
often secondary antibodies against own RBCs infection, neoplasia (lymphoma), drugs more common in dogs, females **cocker spaniels*** Findings: anemia, usually regenerative, Spherocytes, monocytes phagocytizing RBCs, ghost cells, agglutination, thrombocytopenia, inflam leukogram, azotemia Tx: glucocorticosteroids (prednisone), immune suppressive drugs
60
``` 5yr cocker spaniel, lethargic, pale, cant stand, icteric mm PCV low Hgb low Retics high Increased segs & bands Agglutination, spherocytes BUN, bili, ALP increased ```
PCV low= anemic Retics high= acute regenerative anemia inflam leukogram increased bili= RBC destruction IMHA
61
Heinz body anemia
oxidatively denatured hemoglobin mostly cats occurs with lymphoma, hyperthyroidism, diabetes mellitus Plants: Wilted red maple leaves, onions, garlic, kale, cabbage Drugs/Chemicals: Acetaminophen, Propylene glycol, zinc, copper/selenium
62
Aplastic Anemia
generalized bone marrow suppression | Caused by: infectious agents (ehrlichia, FeLV), immun-mediated destruction, drugs, chemicals
63
Anemia of Renal Dz
``` insufficient erythropoetin uremic toxins excess PTH hypocalcemia bleeding tendencies ```
64
Anemia of Inflam Dz
mild to moderate low serum iron increased storage iron eruthroid suppression
65
Endocrinopathy-related anemia | Hypothryroidism
most common mild anemia decreased metabolic rate
66
Endocrinopathy-related anemia | Hypoadrenocorticism
mild anemia, often masked by dehydration
67
``` 10yr cat, lethargy, polydypsia PCV low Retics high Heinz bodies Glu high Phos low Ketones high ```
Heinz bodies & low phos= hemolytic anemia | high glu & ketones = Diabetic ketoacidosis
68
``` 11yr mal cat, diabetic PCV low TP high Retics high nRBCs Smear showed RBCs with several small dots in them ```
blood destruction bc TP is not low think Hienz bodies bc of diabetes nRBCs= regenerative Blood smear= Mycoplasma hemofelis
69
``` 15yr Staffordshire terrier PCV low Retics high Glob increased Lymphs high Bands high Segs high ``` changed to a non reg thrombocytopenia after 10ms saw chains of dots in RBCs on smear
high retics= regen high glob with increased lymphs --> think erhlicia high bands= inflam Mycoplasma haemocanis on smear Ehrlichia titer ++++
70
What sets off the coagulation cascade?
Tissue factor III initiates the coagulation
71
Fibrinogen to fibrin requires ____
thrombin
72
What drives amplification?
thrombin (IIa)
73
Increases in FDPs adn D dimers indicate increased intravascular coag with ____
clot breakdown
74
Patients with protein losing nephropathies (PLN) are ____
hypercoaguable! | antithrombin is not breaking clots down
75
Intrinsic vs extrinsic
brad PiTT is my PeT intrinsic PTT extrinsic PT
76
Vitamin K deficiency
``` Warfarin 2,7,9,10 CS: bleeding, anemia, weakness, hypovolemia, shock, dyspnea, lame, neuro signs, death CBC: reg anemia, PLT norm Prolonged PT and PTT Tx: give vit K, transfusion ```
77
Which factor has the shortest half life?
factor 7
78
Disseminated Intravascular Coagulation (DIC)
continued activation of coagulation and fibrinolysis -decreased PLT bc they are all used Causes: sepsis, tissue necrosis (saddle thrombus), neoplasia, endothelial damage, proteolytic enzymes venom Two phases: hypercoaguable phase (thrombosis) & consuptive phase (bleeding) CS: organ dysfunction due to thrombus, bleeding, mucosal (petychia), hemorrhage
79
What is the cardinal (first) change in DIC?
thrombocytopenia
80
A 3yo NM basset hound presents after owners found an empty package of chewed up rat poison . What dx test would you want to do?
PT: prothrombin time
81
Prior to biopsying a liver, screen for
coagulation abnormalities. Don't want them to bleed out
82
``` 6yr SF cocker spaniel. Lethargy, mucosal petchiae & ecchymoses, occulat hemorrhage. PLT low BMBT prolonged PT norm PTT norm FDP norm ```
Idiopathic thrombocytopenia (ITP)
83
If you transfuse a DEA 1.1 positive dog with DEA 1.1 neg blood you can expect
no rxn | will be fine the 1st time, not the 2nd time
84
If you transfuse a type B cat with a type A, you can expect
a severe transfusion rxn
85
Agglutination is a ____ rxn
positive rxn | agglutination = blood type
86
Major crossmatch
patient serum + donor RBCs
87
A positive crossmatch results in agglutination so we
DO NOT transfuse | BAD
88
Safe to transfuse when
there is NO agglutination
89
A new dog presents with IMHA. The P is stable but needs a transfusion today. You have no hx so what do you do?
blood type and crossmatch the P! | he is stable and we have no hx
90
A dog presents anemic after hemorrhage from a HBC. You are planning a transfusion. Donor blood type: DEA 1.1 neg Recipient Blood type: DEA 1.1 neg Major Crossmatch: neg
Blood types match=good! no crossmatch rxn=good! go ahead and transfuse!
91
A dog being managed post-transfusion. Overnight P continues crystalloid fluid therapy. On physical exam the patient is BAR, with normal mm color and stable vitals. There are no PE findings. Why is PCV decreased? Before transfusion: 18% After transfusion: 24% Today: 23%
dilution from intravenous fluid therapy
92
Red tube
biochem profile | serum
93
EDTA
``` CBC- preserves cell morphology** fibrinogen retic count buffy coat fluid analysis ```
94
Heparin
inhibits thrombin chem panel avian/reptile CBC & chem
95
Citrate
coagulation tests
96
Oxalate tube
plasma glucose
97
Which tube contain calcium chelators?
blue, purple, grey
98
When filling tubes, be careful not to contaminate the
red top tube with EDTA contents
99
What electrolyte abnormalities are expected in a chemistry sample that contains EDTA?
increased K, decreased Ca
100
When an EDTA tube is underfilled, what changes to the RBCs are seen on the CBC?
decreased PCV & MCV
101
Low PCV High MCV Low MCHC Low TP
Low PCV=anemia High MCV=regeneration Low TP=blood loss regenerative anemia due to blood loss
102
A test with a high PPV (positive predictive value) has very few ____
false positives | confidence in a positive test result is high
103
A test with a high NPV (negative predictive value) has very few ____
false negative results | confidence in a neg test result is high
104
Prevalence of a dz will affect the ___ & ___ and therefore, your interpretation of test results
PPV & NPV
105
MCHC is a ____ parameter
calculated
106
The tail to the right of RBC peak indicates
larger, immature RBC precursors | Increased RDW- red cell distribution width
107
What happens to RBCs that stand out at room temp too long?
swell & falsely elevate MCV | best to run samples immediately
108
If lymphocyte conc >35,000ul =
leukemia
109
If lymphocyte conc >15,000ul and tick dz negative =
leukemia
110
Acute lymphoblastic leukemia (ALL)
CS: pale mm, splenomegaly, hepatomegaly, lethargy, weight loss CBC: anemia, thrombocytopenia, lymphocytosis, lymphoblasts in blood Prognosis is poor
111
Chronic lymphocytic leukemia
more common in dogs | lymphocytes maybe smaller
112
Multiple Myeloma
proliferation of plasma cells CS: lethargy, anorexia, lameness, bleeding from nares, PU/PD Lab: >20% plasma cells in bone marrow, monoclonal gammopathy, lytic lesions in bones, increased TP from globulin
113
Isosthenuria
1.008-1.012 | kidney is not adjusting urine conc
114
Hyposthenuria
dilute | <1.007
115
Oliguria
decreased urine production
116
Stranguria
straining to urinate
117
Azotemia
increased urea nitrogen w/ or w/o increased creatinine
118
Uremia
excessive urea in blood with CS of renal failure
119
Renal Functions
``` Produces erythropoietin, renin activate vit D (Ca, Phos) Regulate blood pressure (RAAS) Excrete waste Conserves important substrates ```
120
With the loss of nephrons, kidneys first lose the ability to _____ and then become ____
conc urine | azotemic
121
BUN is filtered by the ____ therefore, it is an indicator of ___
glomerulus | GFR
122
BUN varies with the rate of:
production by the liver reabsorption by kidney (& GI-ruminants) excretion
123
Liver: Increased production of BUN leads to a ___ serum BUN
increased | increased protein in upper GI- upper GI bleed
124
When GFR decreases, BUN ____ in blood. Slow flow rate thru tubules, ___ BUN resorbed which means ___ serum BUN
increases (backs up) increases increased
125
Liver: decreased BUN can be from
portosystemic shunt PSS decreased protein in diet hepatic insufficiency (>80%)
126
Decreased BUN with ___ tubular flow, ____ GFR
increased increased less time to resorb BUN means decreased BUN
127
Creatinine (Crea)
muscle cells release Crea into plasma filtered by glomeruli and excreted NOT reabsorbed by kidney higher in animals with high muscle mass
128
Creatinine is an excellent indicator of If crea is increased in blood, it implies:
GFR decrease GFR, altered nephron function
129
Decreased Crea may represent
poor muscle mass not clinically significant
130
The conc of BUN is dependent upon what 3 things?
dietary protein liver function GFR
131
SDMA Symmetric Dimethylarginine increases with ___% of renal tubular damage
40% | **early indicator of kidney dz**
132
USG: the kidney's ability to concentrate and dilute urine requires ____% functional nephrons
33%
133
The higher the USG, the __ concentrated the urine
more
134
Hypersthenuria
concentrated urine >1.035 cat >1.031 dog
135
Urine specific gravity should always be interpreted with
hydration status
136
Polyuria
``` increased urination kidney loses ability to conc urine implies 66% loss of functional renal mass isosthenuria will also have polydipsia ```
137
Azotemia
increased BUN and/or increased Crea | implies 75% (2/3) loss of renal tubular function
138
Pre-renal azotemia
``` increased BUN, crea, USG -dehydration -shock -upper GI bleed Decreased GFR ```
139
Renal azotemia
Increased BUN, Crea and Decreased USG from decreased GFR loss of kidneys conc ability, isosthenuria -infectious, toxins, hypoxia, neoplasia, neoplasia, congenital
140
Post-renal azotemia
increased BUN, crea and variable USG Obstruction of urinary outflow distal to nephron -FLUTD, goat urolithiasis -uroabdomen (leaks into peritoneal cavity), trauma BLOCKED TOM, straining
141
What occurs first: azotemia or polyuria?
polyuria
142
Azotemia + Isosthenuria =
renal dz until proven otherwise
143
There is a risk of mineralization of soft tissues if Ca X Phos > ____
70
144
As renal failure progresses, ___calcemia develops
hypo Ca starts out normal in renal dz
145
hypocalcemia stimulates ___ to release ____
parathyroid PTH (decrease Ca, increased PTH)
146
___kalemia in chronic renal failure
hypo
147
In acute renal failure and urethral obstructions, ___kalemia can be life threatening
hypo decreased HR
148
Sodium and Chloride are normal in most cases of renal failure but ___ in chronic renal failure
low
149
Protein strips are best at detecting what in the urine?
albumin
150
Most common cause of proteinuria is
UTI
151
4 yr old male goat is straining to urinate. What category of azotemia does he have?
post renal
152
Urine protein:crea ratio < 0.5 is ___ > 0.5 is ___ > 1.0 is ____
normal tubular or glomerular glomerular
153
Glomerulonephropathy
hypoalbuminemia proteinuria renal insufficiency
154
____ differentiates acute from chronic renal failure
speed of development, not severity
155
Uroabdomen
hyperkalemia*** hyponatremia*** caused by trauma or chronic urethral obstruction
156
The kidneys ___ sodium and chloride and ___ crea, urea, potassium
conserve | excreted
157
Increased TP means
dehydration
158
Big sign of Chronic renal failure vs acute
low BCS
159
What level of bili is normal in dogs?
low level/ trace
160
Trypsin like immunoreactivity (TLI)
Sensitive and specific test for EPI >5 norm <2.5=EPI (Exocrine pancreatic insufficiency)
161
Increase in folate makes us think
bacterial overgrowth
162
PTH increases serum ___ by increasing renal tubular reabsorption and by promoting activation of vit D
Ca
163
Calcitonin inhibits ___ which decreases serum __ levels
PTH | Ca
164
Decreased ionized Ca is ____ | Increased ionized Ca is ____
acidosis | alkalosis
165
Common causes of hypocalcemia
``` renal dz ethylene glycol pancreatitis eclampsia sepsis (hypoparathyroidism) ```
166
When you have low Ca and low PTH the animal probably has what?
primary hypoparathyroidism | PTH hasn't kicked in to replace Ca yet so its not working properly
167
Low Ca and high Cholesterol make us think what dz?
pancreatitis
168
Addisons dz, hypoadrenocorticism lab data
lymphocytosis Na (low) /Potassium (high) ratio mild hypercalcemia
169
Lymphoma lab data
hypercalcemia | lymphocytosis
170
Hypermagnesemia
seen only when renal function is compromised
171
Insulinoma
if BG <60 (low glucose) and insulin is high inappropriate insulin release insulin producing tumor
172
Fructosamine is used to rule out
excitement hyperglycemia
173
Barn cat, increased glu, increased lymphocytes
excitement
174
Very old cat, vomiting, high glu
intestinal adenocarcinoma
175
Creatine Kinase (CK)
muscle specific increased from necrosis, IM injections, trauma, exercise, down cows, anorexic cats SHORT HALF LIFE, increases rapidly after injury not good to check for heart attack since it has short half life
176
Aspartate Aminotransferase (AST)
muscle or liver increases slower than CK but stays longer better to check for heart attack
177
ALT
liver specific but can increase with SEVERE muscle damage
178
Myoglobin
pos Hgb dipstick cleared from serum evidence of muscle injury
179
Hemoglobin
pos Hgb dipstick remains in serum evidence of hemolysis
180
SDH
liver specific | large animals
181
GLDH
liver specific | large animals
182
GGT
associated with bile duct | cholestasis, steroids, hepatic injury
183
ALP
bile surface-cholestasis hyperthyroidism increase w/o increase bili suspect steroids or anticonvulsant meds
184
Increased bili
RBC destruction food deprivation cholestasis
185
ALB
chronic liver dz | increase >60% function loss
186
GLOB
chronic liver dz
187
Cholesterol increase
cholestasis
188
Cholesterol decrease
liver failure
189
Most common liver dz in dogs
primary chronic hepatitis
190
Breed predispositions in chronic hepatitis with Cu
doberman pinscher west highland terrier sky terrier
191
Amylase
3-4x upper limit suggests pancreatic injury
192
Lipase
2x upper limit suggests pancreatic injury | dogs receiving steroids
193
Pancreatic lipase immunoreactivity PLI
good sensitivity use for pancreatitis best test!!!!
194
Pure transudates
lack of oncotic pressure low ALB <6,000 NCC
195
Modified transudate
inpaired blood flow | heart dz, obstruction, portal vein issues
196
Exudates
inflam TP >3 NCC >6,000 cloudy/cellular
197
Cat high protein, low cell conc
FIP

Clin Path (6 decks)

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