Clin Path Exam 1

Front 1

what is the lifespan of an erythrocyte?

Back 1

70-160 days (note dogs > cat)

Front 2

how long does it take to see new RBCs after EPO release from the renal cortex?

Back 2

2-3 days

Front 3

why are iron deficient RBCs microcytic?

Back 3

the rubricytes undergo an extra, 5th division

Front 4

what do you call a circulating reticulocyte that is stained with Diff-Quik?

Back 4

hypochromatocyte

Front 5

what are three things that can cause an elevated MCHC?

Back 5

1. intravascular hemolysis
2. poor sample handling (in vitro hemolysis)
3. Heinz Bodies

Front 6

long does it take myeloid stem cells to proliferate?

Back 6

2-5 days

Front 7

how long does it take to see a full regenerative response to anemia?

Back 7

7-10 days

Front 8

how long after bleeding resolves does it take for reticulocytes to return to normal?

Back 8

1-2 weeks

Front 9

what are five signs of a regenerative anemia?

Back 9

1. macrocytosis (assuming many retics)
2. hypochromia (assuming many retics)
3. reticulocytosis
4. hypercellular bone marrow
5. metarubricytes (nRBCs)

Front 10

what is the fancy name for a nucleated red blood cell?

Back 10

metarubricyte

Front 11

what type of poikilocytes do you see with iron deficiency?

Back 11

keratocytes, schistocytes, acanthocytes, microcytes

Front 12

why does epinephrine release cause lymphocytosis?

Back 12

because it stops circulating lymphocytes from getting into the lymph node

Front 13

what type of reticulocytes are counted and not counted in the cat when diagnosing regenerative anemia? Why?

Back 13

- aggregate - counted
- punctate - not counted
- aggregate are 12-24 hours in the circulation and are indicative of regeneration; punctate have been 10-14 days in the circulation

Front 14

what are seven causes of inappropriate metarubricytosis?

Back 14

1. severe hypoxia
2. lead toxicity (uncommon)
3. bone fractures
4. heat stroke
5. leukemia/infiltrative bone marrow disease
6. splenic disease or injury
7. marked extramedullary hematopoiesis

Front 15

what two chemicals are made by the body to adapt to chronic blood loss?

Back 15

1. EPO
2. 2,3-DPG

Front 16

what are three differentials for chronic GI hemorrhage?

Back 16

1. parasites
2. neoplasia
3. ulcers

Front 17

how does iron deficiency affect
- plasma protein?
- platelet count? (why?)

Back 17

- panhypoproteinemia
- thrombocytOSIS (due to cytokine release)

Front 18

what are the end products of hemoglobin that has been phagocytized?

Back 18

- hemoglobin → heme + globin
- globin → amino acids
- heme → iron + bilirubin

Front 19

why is unconjugated bilirubin soluble in the blood?

Back 19

because it is bound to albumin

Front 20

where do the majority of the macrophages that phagocytose RBCs reside?

Back 20

in the SINUSOIDS of the spleen (not the BVs)

Front 21

what are three lab findings that suggest INTRAvascular hemolysis, rather than extravascular hemolysis?

Back 21

1. hemoglobinemia
2. hemoglobinuria
3. ghost cells

Front 22

how do you test for autoimmune hemolytic anemia?

Back 22

1. direct antiglobulin test
2. visualize autoagglutination on a slide

Front 23

how will autoagglutination affect your CBC?

Back 23

artificially ↓RBC and ↑MCV

Front 24

what are two specific RBC changes with oxidative damage and why do these changes occur?

Back 24

1. Heinz Bodies - damage to hemoglobin
2. eccentrocytes - oxidative damage to the RBC cell membrane

Front 25

how can oxidative damage cause intravascular hemolysis?

Back 25

Heinz bodies weaken the RBC membrane, which may lyse in circulation, producing hemoglobinemia and ghost cells

Front 26

why is hemoglobinemia bad, other than it may be concurrent with anemia?

Back 26

it damages renal tubules (horse >> dog, cat)

Front 27

what liver protein binds to free hemoglobin to scavenge it?

Back 27

haptoglobin

Front 28

what is the difference between indirect and direct hyperbilirubinemia.

Back 28

- Indirect: IVH → bilirubin in blood exceeds liver capacity; since the bilirubin is not conjugated and is albumin-bound, no bilirubinuria
- Direct: formation of conjugated bilirubin in liver → liver can't dump it into bile fast enough, so it spills into blood; bilirubinuria will occur

Front 29

what are the four general causes of decreased RBC production?

Back 29

1. anemia of chronic disease (most common)
2. renal failure (↓EPO)
3. generalized bone marrow disease (infiltrated by neoplasia, infection, fibrosis)
4. erythroid hypoplasia or aplasia

Front 30

what are four causes of erythroid hypoplasia or aplasia?

Back 30

1. destruction and/or apoptosis of RBC progenitors
2. chronic, late iron deficiency
3. endocrine disorders (hypothyroidism)
4. cobalamin or folate deficiency

Front 31

how many functional nephrons are lost in CRF?

Back 31

> 75%

Front 32

what is the USG range for isosthenuria?

Back 32

1.008 - 1.012

Front 33

what is the upper normal limit of USG for the
- dog?
- cat?
- horse, cow?

Back 33

- dog: 1.030
- cat: 1.035
- horse, cow: 1.025

Front 34

what protein is made to sequester iron in anemia of chronic disease? Where is it produced, and what stimulates its production?

Back 34

hepcidin. Produced by the liver in response to inflammatory cytokines (IL-6 and others)

Front 35

what is a cause of primary absolute erythrocytosis?

Back 35

polycythemia vera

Front 36

what causes secondary absolute erythrocytosis?

Back 36

increased EPO. Appropriate from low oxygen (respiratory disease or high elevation); inappropriate from an EPO secreting tumor

Front 37

what are two causes of relative erythrocytosis?

Back 37

1. dehydration / hemoconcentration
2. splenic contraction (e.g. epinephrine release)

Front 38

what is the preferred technique for a WBC differential?

Back 38

manual

Front 39

what is the chemical mediator of a physiologic neutrophilia?

Back 39

epinephrine (excitement)

Front 40

describe a physiologic ('excitement") CBC

Back 40

- neutrophilia (no left shift)
- lymphocytosis
- erythrocytosis
- thrombocytosis

Front 41

how long does physiologic/excitement neutrophilia last?

Back 41

about 20 minutes

Front 42

describe a stress leukogram

Back 42

- leukocytosis
- neutrophilia (± clinically insignificant left shift)
- lymphopenia
- monocytosis
- ± eosinopenia

Front 43

what are three causes for excess circulating corticosteroids and thus a stress leukogram?

Back 43

1. severe physical or emotional stress
2. Hyper-A
3. Iatrogenic (e.g. prednisone)

Front 44

what causes neutrophilia in a stress/corticosteroid leukogram?

Back 44

1. ↓margination
2. ↑bone marrow release
3. ↓emigration to the tissue neutrophil pool

Front 45

what comprises the neutrophil proliferation pool?

Back 45

1. stem cells
2. myeloblast
3. progranulocyte
4. myelocytes

Front 46

what comprises the neutrophil storage pool?

Back 46

1. metamyelocytes
2. bands
3. segs

Front 47

how long does a neutrophil circulate in the blood?

Back 47

10 hours

Front 48

how long does a neutrophil survive in the tissues?

Back 48

2 days

Front 49

hypersegmented neutrophils are usually related to what?

Back 49

cortisol (stress neutrophilia)

Front 50

how long does a stress neutrophilia last?

Back 50

hours to days

Front 51

what is the normal ratio of marginal:circulating neutrophils?

Back 51

- 1:1 in most animals
- 1:3 in cats

Front 52

how long from myeloid stem cell to:
- storage pool?
- blood?

Back 52

- 2.5 days (five cell divisions in the proliferation pool)
- 5 days (proliferation pool → storage pool; no divisions in the storage pool)

Front 53

describe an acute inflammatory leukogram?

Back 53

- note "acute" refers to inflammatory type, not time of insult
- neutrophilia
- orderly left shift (bands > reference range; ± metamyelocytes)
- ± lymphopenia (stress most likely reason)

Front 54

what cytokine stimulates the neutrophil proliferation pool

Back 54

GM-CSF, secreted by T cells

Front 55

how long must inflammation persist before you start seeing myeloid hyperplasia?

Back 55

> 2 days

Front 56

what is the difference between neutrophil toxic and degenerative change?

Back 56

- toxic = cytoplasm change
- degenerative = nuclear change

Front 57

how do you interpret neutrophil toxic change without a neutrophilia or left-shift

Back 57

inflammation

Front 58

what are four changes in neutrophil appearance?

Back 58

1. Döhle bodies
2. cytoplasmic basophilia
3. cytoplasmic foamy vacuolization
4. retention of primary granules

Front 59

what is a degenerative left shift?

Back 59

bands > segs

Front 60

what neutrophil changes would you see with very severe inflammation?

Back 60

1. degenerative left shift
2. leukemoid response
3. neutropenia (inflammatory; bone marrow disease; transient--endotoxemia)

Front 61

how many neutrophils would you see in a leukemoid response?

Back 61

> 50,000 (in the dog)

Front 62

what are three important types of neutropenia?

Back 62

1. inflammatory - excessive tissue demand
2. endotoxemia - sequestration (margination)
3. decreased production (bone marrow)

Front 63

what three effects on neutrophils does endotoxemia have?

Back 63

1. ↑ neutrophil production
2. ↑ bone marrow release of neutrophils
3. ↑ tissue demand

Front 64

decreased neutrophil production by bone marrow is called what?

Back 64

myeloid hypoplasia / granulocytic hypoplasia

Front 65

what are five differentials for myeloid hypoplasia?

Back 65

1. infection (e.g. parvovirus)
2. primary or metastatic bone neoplasia
3. toxicosis
4. necrosis
5. myelofibrosis

Front 66

what is myelophthisis?

Back 66

bone marrow infiltrated and crowded out by neoplasia, fibrosis, etc.

Front 67

what is the lifespan of a platelet?

Back 67

5-7 days

Front 68

what is a major difference between the leukogram of a small animal versus a ruminant?

Back 68

lymphocytes > neutrophils 1:1 - 2:1

Front 69

why might you see neutropenia and a left shift in a ruminant with severe acute inflammation?

Back 69

because they have a small neutrophil storage pool

Front 70

what can happen to the leukogram of a ruminant that has inflammation and stress?

Back 70

N:L inversion (N > L)

Front 71

in a ruminant with an acute inflammatory neutropenia, how long would you expect a recovery of neutrophils if all is well?

Back 71

4 days

Front 72

what are the major (-) and (+) acute phase proteins?

Back 72

- (+) fibrinogen, globulin
- (-) albumin

Front 73

what is a useful blood chemistry measurement to determine if inflammation or dehydration is present in a ruminant?

Back 73

PP:fibrinogen ratio

Front 74

when is using the PP:fibrinogen ratio appropriate when evaluating the blood chemistry of a ruminant?

Back 74

when they have HYPERfibrinogenemia

Front 75

what are 2 causes for hyperfibrinogenemia?

Back 75

1. dehydration (relative increase)
2. inflammation (absolute; positive APP)

Front 76

what four places produce lymphocytes?

Back 76

1. lymph nodes
2. thymus
3. spleen
4. GALT

Front 77

what are four causes of lymphopenia?

Back 77

1. glucocorticoids (stress)
2. acute inflammation
3. loss or blocked flow of lymph (ruptured thoracic duct/PLE)
4. lymphoid hypoplasia/aplasia (congenital or acquired)

Front 78

why does stress produce a lymphopenia?

Back 78

- glucocorticoids
1. lymphocytes trapped in the lymph nodes
2. redistribution to lymphocytes to bone marrow
3. chronic stress: lymphoid hypoplasia → ↓lymphopoiesis

Front 79

why does acute inflammation produce lymphopenia?

Back 79

- cortisol
1. lymphocytes to inflamed tissue
2. lymphocytes to lymph node
3. lymphocytes stay in lymph node

Front 80

what are four causes of lymphocytosis?

Back 80

1. chronic inflammation or antigenic stimulation
2. physiologic (epinephrine)
3. neoplasia
4. Hypo-A (mild; due to ↓glucocorticoids)

Front 81

what are three causes of monocytosis?

Back 81

1. stress (cortisol; demargination)
2. inflammation (tissue demand for neutrophils)
3. compensatory to neutropenia ("the B team")

Front 82

how long do monocytes circulate in the blood?

Back 82

10-12 hours

Front 83

how long do eosinophils circulate in the blood?

Back 83

10 hours

Front 84

how long do eosinophils live in tissue?

Back 84

> 2 days

Front 85

what is the difference in the CBC between acute leukemia and chronic leukemia?

Back 85

acute leukemia has many blast cells, where chronic leukemia has small cells that may look identical to non-neoplastic lymphocytes

Front 86

what is the appearance of lymphoma on a lymph node biopsy?

Back 86

mostly lymphoblasts; normal should be >90% small lymphocytes

Front 87

what are the common locations for plasma cell tumors?

Back 87

- cutaneous (usually benign)
- bone marrow
- spleen

Front 88

number of platelets for
- spontaneous bleeding
- induced bleeding

Back 88

- spontaneous: < 25,000
- induced: < 50,000

Front 89

what are the factors for the intrinsic system?

Back 89

12, 11, 9, 8

Front 90

what are the factors for the extrinsic system

Back 90

7, 3

Front 91

when does a prolonged ACT test not caused by a coagulation defect?

Back 91

with severe (< 10,000) thrombocytopenia

Front 92

what system does the ACT test?

Back 92

intrinsic & common

Front 93

what system does the PTT test?

Back 93

intrinsic & common

Front 94

what system does the PT test?

Back 94

extrinsic & common

Front 95

what does a prolonged TT test indicate?

Back 95

hypofibrinogenemia or excessive FDPs

Front 96

what is a normal platelet range at 100X?

Back 96

10-25

Front 97

how do thrombopoietin (TPO) and platelet count relate?

Back 97

- TPO adsorbs to platelet surface
- fewer platelets = more free TPO
- more platelets = less free TPO
- free TPO → megakaryocytic hyperplasia

Front 98

what are the four general causes of thrombocytopenia?

Back 98

1. peripheral destruction
2. decreased production
3. consumption
4. sequestration (e.g. in spleen)

Front 99

what are three differentials for immune-mediated thrombocytopenia?

Back 99

1. tick-borne diseases (e.g. A. phagocytophilum, E. canis, RMSF, Babesia, Bartonella)
2. drug reactions
3. paraneoplastic

Front 100

what are two major causes of consumption of platelets?

Back 100

1. DIC (severe thrombocytopenia)
2. blood loss (mild to rarely moderate)

Front 101

what are four causes of acquires thrombopathia?

Back 101

1. uremia
2. drugs (aspirin, NSAIDs)
3. hetastarch
4. supplements (e.g. ω-3 FA)

Front 102

what are four differentials for thrombocytosis?

Back 102

1. excitement
2. chronic bleeding/iron deficiency
3. inflammation (IL-6)
4. essential thrombocytopenia (> 1+ million)

Front 103

describe two major coagulation abnormalities of the intrinsic pathway

Back 103

- Hemophilia A - Factor 8 - x-linked
- Hemophilia B - Factor 9 - x-linked

Front 104

what is the most common extrinsic pathway inherited defect, and what breed is predisposed?

Back 104

Factor 7 deficiency, reported in beagles

Front 105

what are the three big differentials for a prolonged PT and PTT?

Back 105

1. Vitamin K antagonism
2. hepatic failure
3. DIC

Front 106

what factors are dependent on Vitamin K?

Back 106

2, 7, 9, 10

Front 107

in early warfarin toxicosis, what test will indicate it first and why?

Back 107

prolonged PT because factor 7 has the shortest half-life of all of the other factors

Front 108

what are five indirect measures of liver function?

Back 108

1. BUN
2. glucose
3. albumin
4. cholesterol
5. coagulation factors

Front 109

which coagulation factor is not produced by the liver?

Back 109

8

Front 110

what RBC abnormality will you commonly see with DIC?

Back 110

schistocytes

Front 111

which in vitro anticoagulant (tube top color) is used for
- CBCs?
- coagulation testing?
- chemistry panels

Back 111

- CBC: EDTA (purple top)
- coagulation: citrate (blue top)
- chemistry: heparin (green top); or you can use red top

Front 112

what does heparin inhibit?

Back 112

thrombin and 10a

Front 113

what are three in vivo anticoagulants?

Back 113

1. AT (ATIII)
2. Protein C
3. Protein S

Front 114

what does antithrombin inhibit?

Back 114

thrombin (2a), 9a, 10a

Front 115

why can protein-losing nephropathy cause a pro-coagulant state?

Back 115

because antithrombin, being similar in size to albumin, is lost in the urine

Front 116

what compound cleaves fibrin, fibrinogen, and cross-linked fibrin?

Back 116

plasmin

Front 117

what is the difference between plasma and serum?

Back 117

plasma has fibrinogen, due to anticoagulants; serum is clotted, and has no fibrinogen.

Front 118

what are four differentials for increased loss of albumin?

Back 118

1. blood loss
2. renal loss
3. PLE
4. inflammatory exudate

Front 119

what are three differentials for decreased production of albumin?

Back 119

1. hepatic failure
2. inflammation (negative APP)
3. severe malnutrition

Front 120

what are two differentials for hypoglobulinemia in a foal?

Back 120

1. FPT
2. combined immunodeficiency