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120 Cards in this Set
- Front
- Back
what is the lifespan of an erythrocyte?
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70-160 days (note dogs > cat)
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how long does it take to see new RBCs after EPO release from the renal cortex?
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2-3 days
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why are iron deficient RBCs microcytic?
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the rubricytes undergo an extra, 5th division
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what do you call a circulating reticulocyte that is stained with Diff-Quik?
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hypochromatocyte
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what are three things that can cause an elevated MCHC?
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1. intravascular hemolysis
2. poor sample handling (in vitro hemolysis) 3. Heinz Bodies |
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long does it take myeloid stem cells to proliferate?
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2-5 days
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how long does it take to see a full regenerative response to anemia?
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7-10 days
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how long after bleeding resolves does it take for reticulocytes to return to normal?
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1-2 weeks
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what are five signs of a regenerative anemia?
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1. macrocytosis (assuming many retics)
2. hypochromia (assuming many retics) 3. reticulocytosis 4. hypercellular bone marrow 5. metarubricytes (nRBCs) |
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what is the fancy name for a nucleated red blood cell?
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metarubricyte
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what type of poikilocytes do you see with iron deficiency?
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keratocytes, schistocytes, acanthocytes, microcytes
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why does epinephrine release cause lymphocytosis?
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because it stops circulating lymphocytes from getting into the lymph node
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what type of reticulocytes are counted and not counted in the cat when diagnosing regenerative anemia? Why?
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- 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 |
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what are seven causes of inappropriate metarubricytosis?
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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 |
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what two chemicals are made by the body to adapt to chronic blood loss?
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1. EPO
2. 2,3-DPG |
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what are three differentials for chronic GI hemorrhage?
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1. parasites
2. neoplasia 3. ulcers |
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how does iron deficiency affect
- plasma protein? - platelet count? (why?) |
- panhypoproteinemia
- thrombocytOSIS (due to cytokine release) |
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what are the end products of hemoglobin that has been phagocytized?
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- hemoglobin → heme + globin
- globin → amino acids - heme → iron + bilirubin |
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why is unconjugated bilirubin soluble in the blood?
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because it is bound to albumin
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where do the majority of the macrophages that phagocytose RBCs reside?
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in the SINUSOIDS of the spleen (not the BVs)
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what are three lab findings that suggest INTRAvascular hemolysis, rather than extravascular hemolysis?
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1. hemoglobinemia
2. hemoglobinuria 3. ghost cells |
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how do you test for autoimmune hemolytic anemia?
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1. direct antiglobulin test
2. visualize autoagglutination on a slide |
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how will autoagglutination affect your CBC?
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artificially ↓RBC and ↑MCV
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what are two specific RBC changes with oxidative damage and why do these changes occur?
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1. Heinz Bodies - damage to hemoglobin
2. eccentrocytes - oxidative damage to the RBC cell membrane |
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how can oxidative damage cause intravascular hemolysis?
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Heinz bodies weaken the RBC membrane, which may lyse in circulation, producing hemoglobinemia and ghost cells
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why is hemoglobinemia bad, other than it may be concurrent with anemia?
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it damages renal tubules (horse >> dog, cat)
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what liver protein binds to free hemoglobin to scavenge it?
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haptoglobin
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what is the difference between indirect and direct hyperbilirubinemia.
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- 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 |
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what are the four general causes of decreased RBC production?
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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 |
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what are four causes of erythroid hypoplasia or aplasia?
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1. destruction and/or apoptosis of RBC progenitors
2. chronic, late iron deficiency 3. endocrine disorders (hypothyroidism) 4. cobalamin or folate deficiency |
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how many functional nephrons are lost in CRF?
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> 75%
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what is the USG range for isosthenuria?
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1.008 - 1.012
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what is the upper normal limit of USG for the
- dog? - cat? - horse, cow? |
- dog: 1.030
- cat: 1.035 - horse, cow: 1.025 |
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what protein is made to sequester iron in anemia of chronic disease? Where is it produced, and what stimulates its production?
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hepcidin. Produced by the liver in response to inflammatory cytokines (IL-6 and others)
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what is a cause of primary absolute erythrocytosis?
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polycythemia vera
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what causes secondary absolute erythrocytosis?
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increased EPO. Appropriate from low oxygen (respiratory disease or high elevation); inappropriate from an EPO secreting tumor
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what are two causes of relative erythrocytosis?
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1. dehydration / hemoconcentration
2. splenic contraction (e.g. epinephrine release) |
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what is the preferred technique for a WBC differential?
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manual
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what is the chemical mediator of a physiologic neutrophilia?
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epinephrine (excitement)
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describe a physiologic ('excitement") CBC
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- neutrophilia (no left shift)
- lymphocytosis - erythrocytosis - thrombocytosis |
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how long does physiologic/excitement neutrophilia last?
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about 20 minutes
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describe a stress leukogram
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- leukocytosis
- neutrophilia (± clinically insignificant left shift) - lymphopenia - monocytosis - ± eosinopenia |
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what are three causes for excess circulating corticosteroids and thus a stress leukogram?
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1. severe physical or emotional stress
2. Hyper-A 3. Iatrogenic (e.g. prednisone) |
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what causes neutrophilia in a stress/corticosteroid leukogram?
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1. ↓margination
2. ↑bone marrow release 3. ↓emigration to the tissue neutrophil pool |
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what comprises the neutrophil proliferation pool?
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1. stem cells
2. myeloblast 3. progranulocyte 4. myelocytes |
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what comprises the neutrophil storage pool?
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1. metamyelocytes
2. bands 3. segs |
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how long does a neutrophil circulate in the blood?
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10 hours
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how long does a neutrophil survive in the tissues?
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2 days
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hypersegmented neutrophils are usually related to what?
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cortisol (stress neutrophilia)
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how long does a stress neutrophilia last?
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hours to days
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what is the normal ratio of marginal:circulating neutrophils?
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- 1:1 in most animals
- 1:3 in cats |
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how long from myeloid stem cell to:
- storage pool? - blood? |
- 2.5 days (five cell divisions in the proliferation pool)
- 5 days (proliferation pool → storage pool; no divisions in the storage pool) |
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describe an acute inflammatory leukogram?
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- note "acute" refers to inflammatory type, not time of insult
- neutrophilia - orderly left shift (bands > reference range; ± metamyelocytes) - ± lymphopenia (stress most likely reason) |
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what cytokine stimulates the neutrophil proliferation pool
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GM-CSF, secreted by T cells
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how long must inflammation persist before you start seeing myeloid hyperplasia?
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> 2 days
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what is the difference between neutrophil toxic and degenerative change?
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- toxic = cytoplasm change
- degenerative = nuclear change |
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how do you interpret neutrophil toxic change without a neutrophilia or left-shift
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inflammation
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what are four changes in neutrophil appearance?
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1. Döhle bodies
2. cytoplasmic basophilia 3. cytoplasmic foamy vacuolization 4. retention of primary granules |
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what is a degenerative left shift?
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bands > segs
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what neutrophil changes would you see with very severe inflammation?
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1. degenerative left shift
2. leukemoid response 3. neutropenia (inflammatory; bone marrow disease; transient--endotoxemia) |
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how many neutrophils would you see in a leukemoid response?
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> 50,000 (in the dog)
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what are three important types of neutropenia?
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1. inflammatory - excessive tissue demand
2. endotoxemia - sequestration (margination) 3. decreased production (bone marrow) |
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what three effects on neutrophils does endotoxemia have?
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1. ↑ neutrophil production
2. ↑ bone marrow release of neutrophils 3. ↑ tissue demand |
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decreased neutrophil production by bone marrow is called what?
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myeloid hypoplasia / granulocytic hypoplasia
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what are five differentials for myeloid hypoplasia?
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1. infection (e.g. parvovirus)
2. primary or metastatic bone neoplasia 3. toxicosis 4. necrosis 5. myelofibrosis |
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what is myelophthisis?
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bone marrow infiltrated and crowded out by neoplasia, fibrosis, etc.
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what is the lifespan of a platelet?
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5-7 days
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what is a major difference between the leukogram of a small animal versus a ruminant?
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lymphocytes > neutrophils 1:1 - 2:1
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why might you see neutropenia and a left shift in a ruminant with severe acute inflammation?
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because they have a small neutrophil storage pool
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what can happen to the leukogram of a ruminant that has inflammation and stress?
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N:L inversion (N > L)
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in a ruminant with an acute inflammatory neutropenia, how long would you expect a recovery of neutrophils if all is well?
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4 days
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what are the major (-) and (+) acute phase proteins?
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- (+) fibrinogen, globulin
- (-) albumin |
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what is a useful blood chemistry measurement to determine if inflammation or dehydration is present in a ruminant?
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PP:fibrinogen ratio
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when is using the PP:fibrinogen ratio appropriate when evaluating the blood chemistry of a ruminant?
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when they have HYPERfibrinogenemia
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what are 2 causes for hyperfibrinogenemia?
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1. dehydration (relative increase)
2. inflammation (absolute; positive APP) |
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what four places produce lymphocytes?
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1. lymph nodes
2. thymus 3. spleen 4. GALT |
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what are four causes of lymphopenia?
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1. glucocorticoids (stress)
2. acute inflammation 3. loss or blocked flow of lymph (ruptured thoracic duct/PLE) 4. lymphoid hypoplasia/aplasia (congenital or acquired) |
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why does stress produce a lymphopenia?
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- glucocorticoids
1. lymphocytes trapped in the lymph nodes 2. redistribution to lymphocytes to bone marrow 3. chronic stress: lymphoid hypoplasia → ↓lymphopoiesis |
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why does acute inflammation produce lymphopenia?
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- cortisol
1. lymphocytes to inflamed tissue 2. lymphocytes to lymph node 3. lymphocytes stay in lymph node |
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what are four causes of lymphocytosis?
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1. chronic inflammation or antigenic stimulation
2. physiologic (epinephrine) 3. neoplasia 4. Hypo-A (mild; due to ↓glucocorticoids) |
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what are three causes of monocytosis?
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1. stress (cortisol; demargination)
2. inflammation (tissue demand for neutrophils) 3. compensatory to neutropenia ("the B team") |
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how long do monocytes circulate in the blood?
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10-12 hours
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how long do eosinophils circulate in the blood?
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10 hours
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how long do eosinophils live in tissue?
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> 2 days
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what is the difference in the CBC between acute leukemia and chronic leukemia?
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acute leukemia has many blast cells, where chronic leukemia has small cells that may look identical to non-neoplastic lymphocytes
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what is the appearance of lymphoma on a lymph node biopsy?
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mostly lymphoblasts; normal should be >90% small lymphocytes
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what are the common locations for plasma cell tumors?
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- cutaneous (usually benign)
- bone marrow - spleen |
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number of platelets for
- spontaneous bleeding - induced bleeding |
- spontaneous: < 25,000
- induced: < 50,000 |
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what are the factors for the intrinsic system?
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12, 11, 9, 8
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what are the factors for the extrinsic system
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7, 3
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when does a prolonged ACT test not caused by a coagulation defect?
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with severe (< 10,000) thrombocytopenia
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what system does the ACT test?
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intrinsic & common
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what system does the PTT test?
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intrinsic & common
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what system does the PT test?
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extrinsic & common
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what does a prolonged TT test indicate?
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hypofibrinogenemia or excessive FDPs
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what is a normal platelet range at 100X?
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10-25
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how do thrombopoietin (TPO) and platelet count relate?
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- TPO adsorbs to platelet surface
- fewer platelets = more free TPO - more platelets = less free TPO - free TPO → megakaryocytic hyperplasia |
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what are the four general causes of thrombocytopenia?
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1. peripheral destruction
2. decreased production 3. consumption 4. sequestration (e.g. in spleen) |
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what are three differentials for immune-mediated thrombocytopenia?
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1. tick-borne diseases (e.g. A. phagocytophilum, E. canis, RMSF, Babesia, Bartonella)
2. drug reactions 3. paraneoplastic |
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what are two major causes of consumption of platelets?
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1. DIC (severe thrombocytopenia)
2. blood loss (mild to rarely moderate) |
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what are four causes of acquires thrombopathia?
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1. uremia
2. drugs (aspirin, NSAIDs) 3. hetastarch 4. supplements (e.g. ω-3 FA) |
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what are four differentials for thrombocytosis?
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1. excitement
2. chronic bleeding/iron deficiency 3. inflammation (IL-6) 4. essential thrombocytopenia (> 1+ million) |
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describe two major coagulation abnormalities of the intrinsic pathway
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- Hemophilia A - Factor 8 - x-linked
- Hemophilia B - Factor 9 - x-linked |
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what is the most common extrinsic pathway inherited defect, and what breed is predisposed?
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Factor 7 deficiency, reported in beagles
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what are the three big differentials for a prolonged PT and PTT?
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1. Vitamin K antagonism
2. hepatic failure 3. DIC |
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what factors are dependent on Vitamin K?
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2, 7, 9, 10
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in early warfarin toxicosis, what test will indicate it first and why?
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prolonged PT because factor 7 has the shortest half-life of all of the other factors
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what are five indirect measures of liver function?
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1. BUN
2. glucose 3. albumin 4. cholesterol 5. coagulation factors |
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which coagulation factor is not produced by the liver?
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8
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what RBC abnormality will you commonly see with DIC?
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schistocytes
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which in vitro anticoagulant (tube top color) is used for
- CBCs? - coagulation testing? - chemistry panels |
- CBC: EDTA (purple top)
- coagulation: citrate (blue top) - chemistry: heparin (green top); or you can use red top |
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what does heparin inhibit?
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thrombin and 10a
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what are three in vivo anticoagulants?
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1. AT (ATIII)
2. Protein C 3. Protein S |
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what does antithrombin inhibit?
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thrombin (2a), 9a, 10a
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why can protein-losing nephropathy cause a pro-coagulant state?
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because antithrombin, being similar in size to albumin, is lost in the urine
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what compound cleaves fibrin, fibrinogen, and cross-linked fibrin?
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plasmin
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what is the difference between plasma and serum?
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plasma has fibrinogen, due to anticoagulants; serum is clotted, and has no fibrinogen.
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what are four differentials for increased loss of albumin?
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1. blood loss
2. renal loss 3. PLE 4. inflammatory exudate |
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what are three differentials for decreased production of albumin?
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1. hepatic failure
2. inflammation (negative APP) 3. severe malnutrition |
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what are two differentials for hypoglobulinemia in a foal?
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1. FPT
2. combined immunodeficiency |