VET377 - the one with the bloods

Alimentary Tract

Common benign mass in cat oral cavity.

Pyogenic granuloma

What is most likely to yield a definitive diagnosis when investigating canine chronic inflammatory enteropathy (IBS)

Response to therapy

What is the most likely cause of regurgitation in an 8-week-old Irish setter puppy with a focal oesophageal stricture? 

Persistent right aortic arch.

GDV risk factors in dogs

• breed (large + giant breed)

• deep chested dogs

• once daily feeding

• aerophagia

• recent exercise after eating

Sequale for an animal that survived ruminal acidosis

• liver abscessation from haematogenous spread of gram +ve bacteria

• laminitis due to ischaemia of laminae

What are the mechanisms of D+?

• Malassimilation e.g. EPI, villous atrophy due to viral infection

• Hypersecretory e.g. enterotoxigenic E. coli

• Exudative/inflammatory e.g. chronic inflammatory enteropathy, food allergy, Johne’s disease

• Hypermotility e.g. intestinal parasites

Clinical signs of Haemonchus contortus infection

• pallor

• bottle jaw

• sudden death

• exercise intolerance

What is the cause of neurological signs in ruminal acidosis?

Thiamine deficiency

What is the main clinical sign seen in a herd of cows where sub acute ruminal acidosis is suspected?

Increased/decreased (cyclical) feed intake

What is the condition required to develop neonatal isoerythrolysis in cats?

Queen type B and kitten type A

What organ is primarily responsible for erythrocyte destruction?

Spleen

Which condition is characterised by decreased erythrocyte mass with normovolemia? 

Post-haemorrhagic with compensation

How can you tell whether the anaemia is regenerative or non-regenerative?

• An increase in the # + % of reticulocytes (reticulocytosis)

• Won’t be able to tell until 48hrs post blood loss

How can you tell whether an anaemia is regenerative or non-regenerative in a horse?

• Since don’t release reticulocytes → compare HCT

• if regenerative, will increase

• if non-regenerative, will decrease or stay same

How would you interpret HGB on a CBC?

refers to Hb inside RBC

How would you interpret HCT on a CBC

• = haematocrit

• % of blood represented by RBC

• should ~ PCV

What measures on a CBC decrease with anaemia?

RBC, HGB, HCT

How would you interpret MCV on CBC?

• = mean corpuscular volume

• ‘avg size of RBC’

• normocytic = normal size

• macrocytic = increased size

• microcytic = reduced size

How would you interpret MCHC on CBC

• = mean corpuscular Hb content

• ‘colour’

• normochromic = normal color

• hyperchromic = more red

• hypochromic = pale RBC

What would result in a normocytic, normochromic anaemia?

• pre-regenerative anaemia

• non-regenerative anaemia

What would result in macrocytic, hypochromic anaemia

regenerative anaemia

• increased cytoplasm dilutes Hb → reduced MCHC

• younger cells = bigger → increased avg cell size

What would result in a microcytic, hypochromic anaemia

Fe deficiency

• reduced Fe → reduced Hb synth → reduced colour

• see leptocytes

What would result in a macrocytic, normochromic anaemia

FeLV

What is a monocyte?

A circulating macrophage

What is a stress leukogram?

Result of Glucorticoid (cortisol) response

• LEMON

• reduced diapedesis → more neutrophils circulating

• increased mobilisation of marginating pools

• immunosuppressive → reduced mobilisation of lymphocytes

• inhib of eosinopoiesis

What does LEMON stand for?

• less lymphocytes + eosinophils

• more monocytes + neutrophils

acute inflammation without left shift

Release of marginal + storage pools

acute inflammation with regenerative left shift

release of marginal + storage pools

• + band neutrophils (neutrophil > band)

• need to look under microscope to ID

acute inflammation with degenerative left shift

• bands > normal neutrophils

• consumed most of circulatory, marginating + storage pools

• severe + mostly associated with sepsis

• often leads to neutropenia

What can result in thrombocytosis?

• inflammation

• iron deficiency

How can a genetic mutation cause acute leukaemia?

It stops maturation with increased cell proliferation.

Which is a cause of appropriate secondary absolute erythrocytosis? 

Chronic hypoxia

What is the difference between relative and absolute increases in HCT + RBC?

relative:

• changes in RBC w/ respect to plasma

• effect of haemoconcentration

• e.g. due to loss of IV water (dehydration)

absolute:

• due to increased erythropoeisis

• primary = BM disorder

• secondary = appropriate (hypoxia) or inappropriate production of EPO

Severity of anaemia classification (HCT/PCV)

• >30 = mild

• 20-30 = moderate

• <20 = severe

What is the name of the nucleated cell?

Metarubricyte

What cells are the arrows pointing to?

Reticulocytes

What cell is this arrow pointing to?

Codocyte

What cell is this arrow pointing to?

Leptocyte

What abnormality can you see in this image?

Heinz bodies

What abnormality can you see in this image?

Eccentrocytes

What is this?

Schistocyte

• RBC fragment with pointed extremities

What is this?

Acanthocyte

• pointed segments (diff to echinocyte)

What is this?

Echinocyte

What is the arrow pointing to?

Spherocyte

What is the arrow pointing to?

Keratocyte

What is this?

Band neutrophil

What is this?

Mature neutrophil

What is this?

Hypersegmented neutrophil

What are these?

Monocytes

What are the big cells near the RBCs?

Eosinophils

What toxic change has happened in this neutrophil?

Foamy vacuolation.

What toxic change has happened in this neutrophil?

Dohle bodies

What toxic change has happened in this neutrophil?

Increased basophilia

The intracellular fluid compartment…

Constitutes 2/3 of total body water and has a high potassium concentration

Hyperkalaemia is most likely to result from ...

oliguria (reduced urine)

Hyperkalaemia could be treated with administration of ...

Insulin

A blood gas panel is performed on a dog. This is most consistent with:

Ethylene glycol toxicity

A blood gas panel is performed on a cat. This is most consistent with:

Airway obstruction

What is the formula for calculating the anion gap?

(Na + K) - (Cl + HCO3)

Aldosterone deficiency will result in:

Hypovolaemia, with subsequent antidiuretic hormone (ADH) secretion

Acute ingestion of a large volume of free water will result in:

Cerebral oedema

Appropriate compensation for a primary metabolic acidosis involves:

Hyperventilation

The most accurate measure of all ECF buffer systems is:

Base Excess

A 9 week old female intact Maltese cross presents for a 2-3 day history of severe vomiting and haemorrhagic diarrhoea (hematochezia). On presentation she is collapsed in shock. Select the pathophysiology that best explains the hyponatremia:

Nonosmotic ADH release due to hypovolaemia.

A 9 week old female intact Maltese cross presents for a 2-3 day history of severe vomiting and haemorrhagic diarrhoea (hematochezia). On presentation she is collapsed in shock. Select the most accurate description of the acid-base disorder:

Mixed disorder (primary metabolic acidosis (high AG) with primary respiratory acidosis

A 9 week old female intact Maltese cross presents for a 2-3 day history of severe vomiting and haemorrhagic diarrhoea (hematochezia). On presentation she is collapsed in shock. Select the most likely cause of the hypokalemia in this case:

Increased gastrointestinal losses with decreased intake.

Which of the following statements about thyroid hormone production is correct?

TRH stimulates the release of TSH from the pituitary.

What is the most common cause of primary hypothyroidism in dogs?

Lymphocytic thyroiditis.

An 8-year-old Labrador Retriever presents with weight gain despite an unchanged appetite. A biochemical profile reveals hypercholesterolemia. What is the correct diagnosis?

Primary hypothyroidism.

What pathological condition can decrease the concentration of ionised calcium?

Metabolic alkalosis

What condition is commonly associated with non-thyroidal illness in dogs?

Hyperadrenocorticism.

Which test has the highest sensitivity for diagnosing canine hypothyroidism?

Total T4

What condition is most likely to be associated with an enlarged, pale-yellow liver?

Diabetes mellitus.

Clinical findings on physical exam for Cushing’s Disease (Hyperadrenocorticism)

• alopecia

• muscle atrophy

• pot belly

• cutaneous hyperpigmentation

• thin skin

What is the pathophysiologic mechanism behind hypercalcaemia in malignancy?

PTH-rp secretion by neoplastic cells

What is hyperviscosity syndrome?

• paraneoplastic syndrome

• often secondary to multiple myeloma

• visual disturbances, neurological signs, bleeding

What is Multiple Myeloma?

• malignant neoplasia of plasma cells

• oncontrolled prod. of IgG → hyperglobulinaemia → hyperviscosity syndrome

Clinical Signs of Multiple Myeloma

• hyperviscosity syndrome

• bone pain + lameness

• increased ALP (from bone)

Which is the cell of origin for a cutaneous histiocytoma in the dog?

Langerhan’s cells

Which of the following is the most benign of the conditions within the histiocytic disease complex?

canine cutaneous histiocytoma complex

Humoral hypercalcaemia of malignancy can be diagnosed by measuring increased circulating concentrations of which hormone?

Parathyroid hormone-related protein

Which of the following peripheral lymph nodes may be palpable in a dog with lymphoma resulting in lymphadenomegaly, but not a normal dog?

Axillary

Which diagnostic test is used to determine if hyperglobulinaemia is monoclonal or polyclonal?

Serum protein electrophoresis

In which species are thymomas most common?

Goats

Which clinical signs result from hyperviscosity syndrome in multiple myeloma?

Neurologic abnormalities

What is this?

Siderotic plaque (incidental aging change, may secondary to previous trauma or haemorrhage).

What is the most likely aetiological agent associated with the gross findings?

Marek’s Disease Virus

What is the likely aetiological agent? 

Burkholderia mallei

An 8 year old female spayed Golden retriever presents for her annual vaccination. She has been clinically well. On physical examination she has enlarged prescapular, popliteal, and inguinal lymph nodes. Lymph node cytology confirms lymphoma. Bone marrow aspiration, and an ultrasound of her liver and spleen fail to detect any evidence of lymphoma in those organs.

Stage the lymphoma.

IIIa

What retrovirus can cause lymphoma in cattle?

Bovine Leukosis Virus

What retrovirus can cause lymphoma in cats?

FeLV

What retroviruses can cause lymphoma in birds?

• Marek’s disease

• Lymphoid Leukosis Virus

What is sarcopenia?

Loss of muscle mass.

What might it mean if only albumin is reduced?

Whole blood loss (haemorrhage)

What are the main differentials for a splenic mass?

• haemangiosarcoma

• nodular hyperplasia

• haematoma

• nodular lymphoma

What is azotaemia?

Increase in creatine ± urea

What is pre-renal azotaemia?

• poor BF (perfusion) to kidneys → increase in creatinine and urea

What is the normal USG for a dog?

USG > 1.030

What is the normal USG for a cat?

USG > 1.035

What does it mean if the USG is below the reference interval?

• the urine is less concentrated (dilute)