Bryan - Clin Path - Test 1 - Winter 2Nd Year

Front 1

What is the first identifiable stage in RBC erythropoiesis?

Back 1

Rubriblast

Front 2

Which developmental stages in erythropoiesis are normally anuclear?

Back 2

Erythrocyte
Polychromatophilic RBC (reticulocyte)

Front 3

What is the difference between a Polychromatophilic RBC and a Reticulocyte?

Back 3

Reticulocyte is stained with new methylene blue stain; Polychromatophilic RBC is stained with a Wright's stain

Front 4

A retained nuclear fragment in a normally anuclear erythrocyte is a __________________.

Back 4

Howell-Jolly Body

Front 5

In which stage of erythropoiesis does hemoglobin development begin?

Back 5

Rubricyte

Front 6

What is the trigger for erythropoietin production? What organ produces this?

Back 6

Hypoxia is detected by the JGA in the kidney to release erythropoietin

Front 7

What are 5 conditions where nucleated RBCs may be seen?

Back 7

Regenerative anemia
Splenic dysfunction
Splenic neoplasia
Hematopoietic neoplasia
Pb poisoning

Front 8

What factors influence RBC deformability?

Back 8

surface:volume ratio
Membrane cholesterol/phospholipid properties
Hgb viscosity

Front 9

T or F:
RBCs use glucose as their sole source of energy.

Back 9

Tru dat!

Front 10

What metabolic pathway protects Hgb from oxidative stress? What molecule provides this protection? What happens if there's a problem with the pathway?

Back 10

Pentose Phosphate Pathway produces NADPH which protects from oxidative stress

Heinz bodies form

Front 11

Which pathway prevents overaccumulation of methemeglobin?

Back 11

Methemeglobin reductase pathway

Front 12

Choose left shift or right shift...
...due to increased Hgb affinity for oxygen.

Back 12

left shift

Front 13

Choose left shift or right shift...
...results in increased availability of oxygen to the tissues.

Back 13

right shift

Front 14

Choose left shift or right shift...
...due to decreased Hgb affinity for oxygen.

Back 14

right shift

Front 15

Choose left shift or right shift...
...results in reduced oxygen availability to the tissues.

Back 15

left shift

Front 16

Choose left shift or right shift...
...increased pH

Back 16

left shift

Front 17

Choose left shift or right shift...
...decreased pH

Back 17

right shift

Front 18

Choose left shift or right shift...
...increased temperature

Back 18

right shift

Front 19

Choose left shift or right shift...
...decreased temperature

Back 19

left shift

Front 20

Choose left shift or right shift...
...decreased DPG (diphosphoglycerate).

Back 20

left shift

Front 21

Choose left shift or right shift...
...increased DPG (diphosphoglycerate)

Back 21

right shift

Front 22

Choose left shift or right shift...
...decreased CO2.

Back 22

left shift

Front 23

Choose left shift or right shift...
...increased CO2.

Back 23

right shift

Front 24

Which organ is chiefly responsible for Fe storage?

Back 24

Liver

Front 25

Body Fe regulated by rate of ________; not ________.

Back 25

Body Fe regulated by rate of absorption; not excretion

Front 26

What regulates the rate of Fe absorption?

Back 26

Fe stores and erythropoiesis rate

Front 27

What are the four methods of evaluating Fe levels?

Back 27

Serum Fe
Serum transferrin
% saturation of transferrin
Serum ferritin

Front 28

transferrin + iron =

Back 28

serum iron

Front 29

total iron binding capacity is the same as...

Back 29

...serum transferrin

Front 30

how much transferrin is bound to iron is also known as...

Back 30

...% saturation of transferrin

Front 31

the circulating storage pool of Fe is...

Back 31

...serum ferritin

Front 32

What is the most common cause of hypoferremia?

Back 32

chronic low-level blood loss

Front 33

Which of the following would be expected clinical data in cases of hypoferremia due to chronic blood loss?

Low serum Fe
Low TIBC
Low serum ferritin

Back 33

Low serum Fe
Low serum ferritin
(should see HIGH OR NORMAL TIBC)

Front 34

Which of the following would be expected clinical data in cases of hypoferremia due to inflammation?

Low serum Fe
Low TIBC
Low serum ferritin

Back 34

Low serum Fe
Low TIBC
(should see HIGH serum ferritin)

Front 35

What is a clinical measurement of transferrin?

Back 35

TIBC (total iron binding capacity)

Front 36

What triggers erythrocyte breakdown?

Back 36

Changes in cell membrane (less deformable)
Cell enzymes

Front 37

What cells remove most RBCs from circulation? Where are these cells located?

Back 37

Macrophages in spleen

Front 38

What is the relative proportion of intra vs. extravascular hemolysis in a non-pathogenic system?

Back 38

10% intravascular
90% extravascular

Front 39

What are two good clinical indicators of increased intravascular hemolysis?

Back 39

Hemeglobinuria
Hemeglobinemia

Front 40

Name a ton of tests that can be used for erythron evaluation!

Back 40

RBC count
PCV
Hgb measurement
Morphology
Retic count
Coomb's test
Indices (MCH, MCHC, & etc)

Front 41

T or F:
PCV = Hematocrit

Back 41

False! The values are usually the same or similar but they are arrived in a different manner (PCV via capillary tube and Hematocrit via instrumental counting)

Front 42

What is a good rule of thumb in estimating target hemoglobin concentration?

Back 42

Hgb in g/dl should be ~1/3 the hematocrit % in mammals.

Front 43

Name two findings that will impact the accuracy of the hemoglobin concentration.

Back 43

Lipemia
Heinz bodies

Front 44

What are the 2 methods for conducting a RBC count?

Back 44

Flow cytometry (light scatter)
Impedence cytometry

Front 45

Which two RBC indices provide indications of RBC population cell size?

Back 45

MCV (mean corpuscular volume)
RDW (red cell distribution width)

Front 46

Which two RBC indices provide indications of RBC population hemoglobin? How do these differ?

Back 46

MCH (mean corpuscular hemoglobin) - uses Hgb and RBC count
MCHC (mean corpuscular hemoglobin concentration) - uses Hgb and PCV

Front 47

What RBC morphology is indicated by the arrows? What condition(s) are associated with these cells?

Back 47

Spherocytes;
Indicative of immune-mediated hemolytic anemia

Front 48

What kind of RBC is indicated by the arrow? What condition(s) are associated with this?

Back 48

Schistocytes;
DIC, Vasculitis, and Hemangiosarcoma

Front 49

What kind of RBC is indicated by the arrows? What condition(s) are associated with this?

Back 49

Echinocytes;
Usually artifactual but can be from electrolyte imbalances, uremia, dehydration

Front 50

What kind of RBC is indicated by the arrow? What condition(s) are associated with this?

Back 50

Acanthocyte;
Associated w/splenic and hepatic disorders and metabolic disorders affecting cell membrane

Front 51

What kind of RBC is indicated by the arrows? What condition(s) are associated with this?

Back 51

Keratocytes (blister and helmet cells);
Caused by RBC trauma (similar to schistocytes)

Front 52

What kind of RBC is indicated by the arrow? What condition(s) are associated with this?

Back 52

Codocytes (target cells);
Excess membrane due to young cells or metabolic disorder

Front 53

What kind of RBC is indicated by the arrow? What condition(s) are associated with this?

Back 53

Dacryocyte;
Artifact or myelopathy

Front 54

What kind of RBC is indicated by the arrow? What condition(s) are associated with this?

Back 54

Stomatocyte;
Hereditary disorder seen in Malamutes

Front 55

What are the two types of Reticulocytes? Which one is unique to cats?

Back 55

Punctate (cats)
Aggregate

Front 56

What index takes into account reticulocyte production/maturation time? What value is considered regenerative?

Back 56

RPI (reticulocyte production index); RPI>2 = regenerative

Front 57

T or F:
More reticulocytes should be found in cases of hemolytic anemia than in blood loss anemia.

Back 57

True!
Hemolytic recycles raw materials.

Front 58

How long does it take to make a reticulocyte? When are peak values usually found?

Back 58

48-72h production time;
7d peak

Front 59

T or F:
Dogs generally have more reticulocytes than cats.

Back 59

True!
<1% dogs; <0.4% cats

Front 60

T or F:
Absence of reticulocytes always indicates a non-regenerative anemia.

Back 60

False!
It can also indicate inadequate response time (haven't made any yet).

Front 61

Which test is used to test for immune-mediated hemolytic anemia?

Back 61

Coomb's test

Front 62

T or F:
Macrocytic hypochromic anemia is a common finding in iron-deficiency anemia.

Back 62

False!
This is typical of regenerative anemia!

Front 63

In terms of laboratory data, how can anemia from internal hemorrhage be discerned from anemia due to external hemorrhage?

Back 63

External hemorrhage would also be hypoproteinemic

Front 64

In a case of hemolytic anemia, predict the values of the following indices:

PCV
Reticulocytes
Protein
RBC Morphology

Back 64

PCV - low
Reticulocytes - high
Protein - normal

Front 65

List some possible causes of hemolytic anemia.

Back 65

Immune-mediated
Drugs
Toxins
Parasites
DIC
Inherited defects
Oxidative injury
Hypophosphatemia

Front 66

What are some examples of parasite-induced hemolytic anemia?

Back 66

Mycoplasma haemofelis
M. haemolamae
M. haemominitum
Babesia canis
Anaplasma marginale

Front 67

What are some examples of hemolytic anemia due to oxidative damage?

Back 67

Garlic/onion toxicity
Red maple toxicity
Cu toxicosis
Acetaminophen toxicity

Front 68

Which of the following is lacking with ineffective or reduced erythropoiesis?


a) stem, progenitor, and precursor cells
b) stimulating/growth factors
c) nutrients (eg: Fe)
d) microenvironment

Back 68

One or more are lacking.

Front 69

What are some differentials for normocytic, normochromic anemia with normal neutrophils and platelets?

Back 69

Renal failure (no erythropoietin)
Anemia of chronic disease/inflammation
FeLV-associated anemia
Immune-mediated

Front 70

What are some differentials for normocytic, normochromic anemia with decreased neutrophils and platelets (pancytopenia)?

Back 70

Infectious anemia
Radiation
Toxins/drugs
idiopathic
Myelophthsis anemia

Front 71

What are the two major lines of leukocytes?

Back 71

Lymphoid and Myeloid

Front 72

What cytokines stimulate neutrophil production?

Back 72

GM-CSF, G-CSF, and IL-3

Front 73

What are the stages of neutrophil development?

Back 73

Myeloblast, promyelocyte, myelocyte, metamyelocyte, band nutrophil, segmented neutrophil

Front 74

What are the two pools of neutrophil population?

Back 74

Marginated and circulation

Front 75

How long do neutrophils spend in circulation?

Back 75

~10h

Front 76

What are neutrophils called in fish, birds, and reptiles?

Back 76

heterophil

Front 77

Macrophages in circulation are called…

Back 77

monocytes

Front 78

How long does it take for monocytes to mature? How long do they circulate?

Back 78

24-36h; 24h circulation

Front 79

Which leukocyte can have stormy blue cytoplasm, vacuoles, and/or pseudopods?

Back 79

monocytes

Front 80

What cytokine stimulates eosinophil produciton?

Back 80

IL-5

Front 81

Identify these cells (note, they are all various stages of the same type of cell).

Back 81

A - Promyelocyte; B - Myelocyte; C - Seg. Neutrophil

Front 82

What type of cell is depicted here? ID the species of A-D. ID the specific subtype of E and F.

Back 82

A - Canine Lymphocyte; B - Feline Lymphocyte; C - Equine Lymphocyte; D - Bovine Lymphocyte; E - Reactive Lymphocyte; F - Granular (NK cell) lymphocyte

Front 83

What is the production time for eosinophils? How long do they remain in circulation?

Back 83

2-6d production; 1hr circulation

Front 84

What is unique about horse eosinophils?

Back 84

large granules (raspberry eosinophil)

Front 85

What is unique about cat eosinophils?

Back 85

rod-shaped granules

Front 86

Which species can have vacuolated eosinophils?

Back 86

Dogs (greyhounds)

Front 87

What is the production time for basophils? How long do they last in circulation? How long in the tissue?

Back 87

2.5d production; 6h in circulation; 2wks in tissues

Front 88

T or F: Eosinophils and basophils are stimulated by the same chemokines.

Back 88

False! Eosinophils are stimulated by IL-5; Basophils by IL-3

Front 89

Which species has indistinct basophil granules?

Back 89

Canine

Front 90

Which species has lavender/gray basophil granules?

Back 90

Feline

Front 91

What are the smallest leukocytes?

Back 91

Lymphocytes

Front 92

Describe a reactive lymphocyte.

Back 92

Larger and bluer than normal lymphocyte

Front 93

What structure indicates that a lymphocyte is antibody producing? What type of lymphocyte is this?

Back 93

White golgi body indicates Ab production of PLASMA CELL

Front 94

What are lymphocytes with magenta granules?

Back 94

NK cells

Front 95

Which leukocyte is mostly nucleus?

Back 95

Lymphocytes

Front 96

What can distort a leukogram?

Back 96

Nucleated RBCs

Front 97

Which type of neutrophil has a kidney shaped nucleus?

Back 97

Metamyelocyte

Front 98

What is the difference between a left shift and a degenerative left shift?

Back 98

Both have significant #s of immature neutrophils; in degenerative L shift, immatures outnumber matures

Front 99

What is the prognosis for animals exhibiting a degenerative left shift?

Back 99

Piss poor

Front 100

Why is a degenerative left shift not bad in ruminants?

Back 100

They have small marrow pool so initial response appears degenerative.

Front 101

Marked neutrophilia coupled with a left shift describes…

Back 101

Leukemoid reaction

Front 102

What are causes of neutrophilia?

Back 102

Physiologic,
corticosteroids,
inflammatory,
hemolysis or hemorrhage,
Myeloproliferative dz

Front 103

Release of epinephrine causes what type of neutrophilia? In which species is this common?

Back 103

Epi releases marginated neutrophils (physiologic neutrophilia); common in foals and cats; also releases lymphocytes

Front 104

What are the hallmarks of a stress leukogram?

Back 104

Neutrophilia, lymphopenia, eosionpenia, monocytosis

Front 105

What can cause neutropenia due to increased margination?

Back 105

Endotoxemia (gram neg bacteria)

Front 106

What are causes of neutropenia?

Back 106

increased margination; increased demand; decreased production; immune mediated; myelophthisis

Front 107

What are causes of monocytosis?

Back 107

Stress leukogram; chronic/acute inflammation

Front 108

What are causes of eosinophilia?

Back 108

Parasitic infection; hypersensitivity; idiopathic; tumor; hypoadrenocorticism

Front 109

What are causes of eosinopenia?

Back 109

Stress leukogram!

Front 110

What are causes of basophilia?

Back 110

similar to eosinophilia!

Front 111

What is the difference between a basophil and a mast cell?

Back 111

Basophil has a lobed nuc; mast cell has a round nuc.

Front 112

What are causes of lymphocytosis?

Back 112

Physiologic; antigenic stimulation; Bovine Leukemia Virus

Front 113

What infectious agents can result in lymphocytosis?

Back 113

Rickettsial disease (erlichia); Bovine Leukemia Virus

Front 114

What are causes of lymphopenia?

Back 114

Stress leukogram; immunosuppression; immunodeficiency; lymph loss (uncommon)

Front 115

What causes the presence of toxic neutrophils?

Back 115

inflammatory mediators affecting bone marrow

Front 116

What are some hallmarks of toxic neutrophils?

Back 116

Increased basophilia to cytoplasm; toxic granules; Dohle bodies

Front 117

What are Dohle bodies?

Back 117

Bluish aggregates of RER found in toxic neutrophils

Front 118

What are examples of vacuolation defects in neutrophils?

Back 118

Chediak-Higashi Syndrome; neutrophil anamoly of Birman cats; storage diseases

Front 119

What neutrophil abnormality can be mistaken for a left shift?

Back 119

Pelger-Huet Anamoly

Front 120

What are causes of neutrophil hypersegmentation?

Back 120

Old blood; corticosteroids; poodle bone marrow dyscrasia

Front 121

Which leukocytes can contain intracytoplasmic organisms?

Back 121

Monocytes and neutrophils

Front 122

What are some examples of intracytoplasmic organisms that can be found within leukocytes?

Back 122

Erlichia; Hepatozoon; Bacteria; viral inclusions; Histoplasma; Leishmania

Front 123

what two things does erythropoietin stimulate?

Back 123

hemoglobin synthesis

erythroid cell maturation

Front 124

a defect in a glycolytic enzyme leads to...

Back 124

hemolytic anemia

Front 125

with intravascular hemolysis, hemoglobin become_____ and binds to _______. if the _______ capacity is exceeded then they're filtered out through the glomerulus

Back 125

dimers

haptoglobin

haptoglobin

Front 126

if the binding capacity of haptoglobin is exceeded, unbound hemoglobin can be either ______ or when uptake capacity is exceeded, ______

Back 126

resorbed

excreted as free hemoglobin

Front 127

in what species is rouleaux formation normal?

in what is it abnormal and what does it indicate?

Back 127

normal= horses and cats

dogs= inflammatory disease

Front 128

names three species that have poikolocytes in a healthy animal

Back 128

calves

pigs

goats

Front 129

what is basophilic stippling? name two scenarios in which it is scene?

Back 129

RNA clumps seen with a WRIGHT'S stain

seen with:

1. lead poisoning

2. regenerative anemia of sheep, cats, and cattle

Front 130

anemia due to hemorrhage or hemolysis will be either _____cytic and _____chromic or ____cytic and ______chromic

Back 130

macrocytic and hypochromic

normocytic and normochromic

Front 131

anemia due to blood loss and accelerated RBC destruction tend to be ________ anemias

Back 131

regenerative

Front 132

reduced or defective erythropoiseis tend to be _______ anemia

Back 132

non regenerative

Front 133

name some clinical signs/lab findings that would help you distinguish intravascular hemolysis from extravascular

Back 133

both have icterus and bilirubinuria

intravscular will also have hemoglobinemia and hemoglobinria

Front 134

what are the hallmarks of immune mediated hemolytic anemia?

Back 134

marked regenerative anemia

sometimes you see auto-agglutination in the sample tube (small speckle/clumps of blood)

Front 135

what does insulin and hemolytic anemia have to do with each other?

Back 135

insulin drives phosphorus into the cells, causes hypophosphatemia, and causes hemolysis

Front 136

the cytokine ______ is responsible for the liver's production of ______ during anemia of chronic disease

Back 136

IL-6

Hepcidin

Front 137

name two causes for relative polychthemia

Back 137

dehydration

splenic contraction

Front 138

how do activated platelets stick to the vessel wall?

Back 138

von willebrand's factor

Front 139

what is the end result of secondary hemostasis?

Back 139

fibrin

Front 140

true or false: secondary hemostasis and fibronlysis are triggered at the same time

Back 140

true

Front 141

what is the precursor to fibrin?

Back 141

fibrinogen

Front 142

who breaks down fibrin?

Back 142

plasmin

Front 143

what are the degradation of fibrin?

Back 143

D dimers

Front 144

what test assesses intrinsic coagulation pathway? extrinsic?

Back 144

intrinsic-PTT

extrinsic- PTT

Front 145

true or false: vessels normally produce activators of blood coagulation

Back 145

false, normally produce inhibitors

Front 146

what is thrombopoesis?

Back 146

platelet formation

Front 147

what's the name for a "platelet" in a bird and reptile?

Back 147

thrombocytes

Front 148

what is the most common reason for non-regenerative anemia?

Back 148

anemia of chronic disease

Front 149

what type of tube do you put a bone marrow sample into?

Back 149

EDTA

Front 150

what are two things that you can glance for to see that you've actually gotten a bone marrow sample?

Back 150

megakaryocytes

fat

Front 151

what cells are seen with acute leukemia? chronic leukemia?

Back 151

acute--very immature blast cells

chronic--mature cells, small, look actually pretty normal

Front 152

define myelodisplastic syndrome

Back 152

cells made in bone marrow that are not maturing normally (ineffective hematopoesis)

Front 153

where does lymphoma start?

Back 153

in solid tissues

CAN go to bone marrow but doesn't start in bone marrow

Front 154

what are some things you can do to further diagnose cells in acute lymphocytic leukemia?

Back 154

immunophenotyping

PCR

Front 155

chronic lymphocytic leukemia can often be confused with..?

Back 155

reactive lymphocytosis

Front 156

to diagnose multiple myeloma, you need two of four diagnostic features. name the four

Back 156

monoclonal gammopathy

bence-jones proteinuria

radiographic evidence of osteolysis

plasma cells in the bone marrow