Small Ani. Med- Cytopenia + Cytosis 2

wilsbach's version from 2015-11-30 00:10

thrombocytopenia + Leukocytopenia

Question Answer
what kinda bleeding charaterizes thrombocytopenia?platelet bleeding occurs on surfaces (epithelium) not cavities (hemoabdomen, hemothorax), so see petechia, ecchymoses, GI loss...
what are the key platelet values which can indicate thrombocytopenia? most important thing to determine if thrombocytopenic is that you..platelet NUMBER, platelet size (MPV), platelet mass? (PM, Pct)....remember that looking at a SLIDE is the MOST important way to determine this, because artifacts (like clumping) are common which mess up machines
3 ways that you can have low platelets are...destruction, loss/consumption, dec production
DESTRUCTION of platelets leading to thrombocytopenia is usually?usually immune mediated (IMT) (1*= idiopathic, 2*=anaplasma platys)
how does IMT (immune mediated thrombocytopenia) (destructive cause of dec platelets) appear upon slide exam?typically VERY LOW platelet counts-- hallmark is SEVERE THROMBOCYTOPENIA! Often also see BIG platelets (inc MPV). May or may not have clinical bleeding
how do you treat IMT (immune mediated thrombocytopenia)?similar to how you treat IMHA- immunosuppression and transfusion, basically
When are occasions where loss/consumption of platelets is the cause of the thrombocytopenia?usually massive bleeding or DIC (severe coagulopathy) -- need a lot of blood loss to actually see a dec in platelets. Variable amount of platelets seen, but prolly not as low as in immune mediated thrombocytopenia
what might cause thrombocytopenia due to dec production?usually BM/megakaryocyte problem. USUALLY see problem with other cell lines too, not just platelets. Usually looking at things like toxicities, neoplasias, bone marrow dzs (myelophthisis, myelofibrosis, etc). RARELY can be lack of thrombopoeitin.... platelet count can be anywhere from 0 to normal
**congenital macrothrombocytopenia-- WHO is prone to get this? what is itCAVALIER KING CHARLES gets is a non-clinical problem where they naturally just have lower platelet numbers but the platelets are bigger on average. *wont see bleeing anywhere with this.
if machine says there is a low count, first thing you do it.. verify with your eyes, look at slide
why are WBCs always first to dec when there is BM problem?WBC lifespan much shorter than RBC or platelet
if JUST a neutropenia, most likely differentials are? (2)severe infxn, IMN (immune mediated)
3 main differentials if just lymphopenia?Stress, steroids, Viral infections (FIV, FeLV…)
2 main differentials if just eosinopenia?stress, steroids


Question Answer
2 reasons we care about erythrocytosis?(1) sign of underlying sz (2) HYPERVISCOSITY can lead to probs
what is the instance where erythrocytosis is merely an artifact to sthing else? how do you know that it's just an artifactual thing?if hypovolemia/dehydration! will know bc total proteins/solids will also be inc
what is the cause of PRIMARY erythrocytosis (what dz) and how do you know it's primary?polycythemia vera-- and you will know bc inc RBCs REGARDLESS OF EPO LEVELS
what is the cause of SECONDARY erythrocytosis-- and how do you know it's secondary?secondary bc secondary to INCREASED EPO!! usually inc EPO because of (1) hypoxia (resp dz, brachycephalics) (2) dec renal blood flow (or renal tumor that makes EPO)
if you have a sig erythrocytosis (high 50s, 60s, 70s) this can impact health- how do you go about treating this?phlebotomy (blood removal) <--primary tx. make sure to replace the fluids. If you think you have polycythemia vera and phlebotomy isnt helping much, can give drug hydroxyurea. Make sure to address any underlying causes.
why do we care about thrombocytosis?abnormal clotting (might inc risk of clots maybe)
RARE, but when can thrombocytosis be a primary problem?called "essential" thrombocytosis, probably neoplastic (kinda like polycythemia vera)
3 main ways thrombocytosis is a secondary problem?(1) splenectomy (esp initially will be dramatic inc-- bc you took out their little hideout place) (2) steroids (Exogenous or enogenous- think cushings) (3) chronic bleeding (esp GI)
most common cause for neutrophilia is...? what other causes?stress leukogram (neutrophilia, monocytosis, lymphopenia, eosinopenia). Other causes can be inflammation (infectious or non-infectious)
what are some other morphological hints which might help you characterize your neutrophilia?seeing bands(de or regenerative left shifts), toxic changes, hypersegmentation might all help you figure out whats going on (note: stress leukogram is a normal and mature neutrophilia)
which dz causes like 20,000 bands? which breed affected?pelger huet, australian shepherds
what might you think the reason is for a moderate monocytosis? Severe?Moderate: stress, inflammation. SEVERE: look for focus of inflammation or necrosis
what might be a case where a lymphocytosis is normal?might be a normal stress response in young cats (less commonly young dogs)
usually lymphocytosis bc...might be non-specific to inflammation in cats, inflammation 2* to non-bact dz (toxo, viruses), neoplasia! (might be normal in young cats to have high lymphocytes when stressed).... but usually think cancers or weird infections
what would there be a eosinophilia?"worms, wheezes, weird dzs" so parasites, allergies, hypersensitivities, cancer, fungus, immune-mediated dzs