HLI 3

Question 1

Where are blood cells produced

Answer 1

Early embryo – yolk sac
Foetus – liver, spleen and bone marrow
Neonate – liver and bone marrow
Adult – bone marrow (spleen & liver with disease and when needed - EMH)

Question 2

What is leukopoesis divided into and how long do they live

Answer 2

1. Lymphopoiesis
2. Myelopoiesis
   - Granulocytes
   - Neutrophils
   - Eosinophils
   - Basophils
   - Monocytes leads to macrophages
   Most have a life span of 2 weeks

Question 3

granule colour of neutrophil, basophil and eosinophils

Answer 3

Neutrophils - granules cannot see
Basophils - granules blue
Eosinophils - granules red

Question 4

Why do leukocytes undergo segmentation

Answer 4

Elongated segmented nucleus

• Easier to get through endothelial cells into the tissues - first to arrive
• Inactive nucleus no transcription

Question 5

Where are neutrophils found in the body and how long in each area

Answer 5

1. Marrow
   ○ Maturation pool
   ○ Storage pool - dogs and cats store up to 5 days
2. Blood
   ○ Circulating neutrophil pool (free moving in vessels) - what we get in the blood sample
   ○ Marginal neutrophil pool (loosely adhered to vessels)
   - 10-12 hours
3. Tissue - 24-48 hours
   - do not recirculate unlike lymphocytes (removal via macrophages)

Question 6

Monocyte kinetics

Answer 6

• Maturation in marrow is rapid (24-36hrs)
• Don’t have to have the segmented nucleus or protein granules produced
  Lifespan - unknown
  Limited recirculating and replication capacity
  Continue to divide

Question 7

Thrombopoeisis what regulated by, timeframe

Answer 7

• Regulated by thrombopoeitin from liver, kidney and marrow stromal cells
• Maturation 2-10 days

Question 8

What is a megakaryocyte and what does it lead to

also what are macro platelets and their implications

Answer 8

Megakaryocyte
- Large mass of nuclear material
- Can be 34 times the normal amount of DNA
- Cytoplasm pinching off that become the platelets
Macro platelets or macro thrombocytes
- Produced from larger pinching of the megakaryocyte when need lots of platelets
- If platelet larger than RBC then classify as this

Question 9

What are the 4 general mechanisms for decrease platelets and examples

Answer 9

1) production - bone marrow disease or EMH
2) consumption - inflammation
3) sequestration - splenomegaly from haemangiosarcoma
4) destruction - immune mediated

Question 10

What percentage of platelets are sequestered in the spleen, life-span and when nucleated

Answer 10

• 30-40% sequestered in spleen within vascular sinusoids, if get splenomegaly then holds more
• Life-span 5 – 9 days
• Nucleated in avians and reptiles (thrombocytes)

Question 11

What are the 3 features of the leukogram

Answer 11

1. Total leukocyte count
2. Differential (individual leukocyte counts)
3. Leukocyte morphology - human only,

Question 12

White blood cell count what are the 3 ways

Answer 12

1. Automated count methods
   ◦ Impedance
   ◦ Flow cytometry
2. Manual count
   ◦ Evaluate in monolayer
   ◦ Est. WBC count x 109/L = 2.0 x average WBC per 40x field
3. Assess morphology (40 or 100x objective in monolayer)

Question 13

What are the 3 features of the leukogram

Answer 13

1. Total leukocyte count
2. Differential (individual leukocyte counts)
3. Leukocyte morphology - human only,

Question 14

White blood cell count what are the 3 ways

Answer 14

1. Automated count methods
   ◦ Impedance
   ◦ Flow cytometry
2. Manual count
   ◦ Evaluate in monolayer
   ◦ Est. WBC count x 109/L = 2.0 x average WBC per 40x field
3. Assess morphology (40 or 100x objective in monolayer)

Question 15

What are the 3 characterstics that automated systems determine in WBC and when should and shouldn’t it be used

Answer 15

• Cell size - forward scatter
• Cell fluorescence - RNA within the cell
• Side scatter (cell complexity) - granularity
  Good with normal leukocytes but misclassifies cells that are abnormal - look at blood smear

Question 16

Neutrophil kinetics for cows, dogs, horses and cats

Answer 16

Cows - 1:1 easily become neutropenic due to small storage pool
Dogs - 1:1 large storage pool (5 days worth)
Horses - 1:1 small storage pool not as small as cows
Cats - 3:1 most neutrophils in the marginating pool, smaller storage pool than dogs but still larger than horse and cow

Question 17

what occurs to neutrophils during the stress response

Answer 17

SUPPRESS IMMUNE SYSTEM
lymphocytes release from bone marrow is decreased
movement of RBC from marginating into circulating pool
- mature neutrophilia
Move red blood cells from marginating into circulating
Neutrophils are also released from the bone marrow

Question 18

What occurs to neutrophils during inflammation

Answer 18

neutrophilia - degree varies

pull from storage pool into circulating and marginating +/- increased marrow production

Question 19

what occurs to neutrophils during excitement (adrenalin mediated)

Answer 19

Mainly in young animals
neutrophilia
- increase in lymphocytes and neutrophils movement from marginating into circulating pool

Question 20

List 4 causes of neutropenia and how occurs

Answer 20

1. Overwhelming inflammatory demand
   - Generally a septic process with a lot of puss formed - pyometra
   - Less disease needed for cows as they have a lower storage pool
2. Transient margination (endotoxaemia)
   - More towards edges of the vessels so not detecting them in the sample
3. Bone marrow disease
   - Make less neutrophils
4. Immune-mediated destruction of neutrophils

Question 21

what results in a neutrophil left shift and the types

Answer 21

= immature neutrophils in blood
• Usually bands
• Regenerative left shift
○ ◦ Mature (segmented) neutrophils > immature (band) neutrophils
• Degenerative left shift
○ ◦ Immature neutrophils > mature nature neutrophils
Can have with normal neurophils

Question 22

What does a degenerative left shift indicate

Answer 22

Tells us bone marrow is desperate - no longer have mature left
More likely to be septic and life threatening - severe inflammation

Question 23

List 2 causes of neutrophil left shift

Answer 23

1. Inflammation
   = High tissue demand for neutrophils
   - Reflects release from maturation pool
2. Can also occur with myeloproliferative disease e.g. chronic myeloid leukaemia (serious bone marrow disease) and neoplasia (paraneoplastic syndrome)

Question 24

List 4 differentials that lead to lymphocytosis

Answer 24

1. Chronic antigenic stimulation
◦ Vaccination
2. Adrenaline/Excitement (young animals)
3. Lymphoid neoplasia
4. Hypoadrenocorticism - lack of cortisol

Question 25

List 3 differentials that lead to lymphopenia

Answer 25

``` 1. Glucocorticoids/Stress - most common ◦ Reduced release from LN and spleen ◦ Lympholysis 2. Acute inflammation - Generally increased stress so get lympholysis or due to movement of lymphocytes into tissues - less circulating 3. Loss of lymphatic fluid ◦ Chylothorax ◦ Enteric neoplasia ◦ Protein losing enteropathy ```

Question 26

List characteristics of monocytes

Answer 26

1) variable nuclear morphology 2) blue-grey cytoplasm 3) larger than neutrophils 4) cytoplasmic vacuoles 5) nuclear never as dense as neutrophils

Question 27

List function of monocytes

Answer 27

1) phagocytosis - foreign material, daed cells 2) source of cytokine and chemotactic factors 3) present antigen to T cells 4) perform antibody-dependent cytotoxicity

Question 28

List 4 differentials that lead to monocytosis and what does mnocytopenia mean

Answer 28

1. Acute inflammation 2. Chronic inflammation 3. Glucocorticoids/stress (dogs) 4. Myeloproliferative disease e.g. myeloid leukaemia clinically insignificant - mainly healthy animals have low numbers

Question 29

List 3 differentials for eosinopenia

Answer 29

1. Glucocorticoids/stress response | 2. Can be clinically insignificant

Question 30

What are the 4 functions of basophils and what are they associated with

Answer 30

1. Histamine release 2. Promote lipid metabolism 3. Haemostasis 4. Parasite control Generally occur with eosinophils - Eosinophilia generally get basophilia

Question 31

How does a scatter plot work for WBC differentiation

Answer 31

each cell going through the analyser gets placed on graph based on fluorescence and granularity - so each type of leukocyte will be placed in a certain area - look at how many dots in that area to see the amount of neutrophils, basophils etc.

Question 32

How does a scatter plot work for WBC differentiation

Answer 32

each cell going through the analyser gets placed on graph based on fluorescence and granularity - so each type of leukocyte will be placed in a certain area - look at how many dots in that area to see the amount of neutrophils, basophils etc - Analyser needs to know the species as the cells change characteristics in different species so certain cells may be identified as something they are not

Question 33

What is toxic change, Why and when does it occur

Answer 33

What? - Neutrophils that show signs of cytoplasmic immaturity - Was able to divide the nucleus but cytoplasm wasn't divided properly Why? - Hastened or disordered maturation in the bone marrow When? - Infections or intense inflammation or myeloproliferative disease Can be associated with nuclear immaturity (left shifting) or seen in cells with mature segmented nuclei

Question 34

What are the 3 main signs of toxic change

Answer 34

1) increase basophilia 2) dolhe bodies 3) vacuoles

Question 35

Ring form neutrophils when seen

Answer 35

low numbers in normal rodents ◦ intense inflammation ◦ chronic myeloid leukaemia ◦ myelodysplasia.

Question 36

hypersegmented neutrophils how many segments considered and causes

Answer 36

- >5 segmentations = Older neutrophils - Chronic glucocorticoid exposure - MOST COMMON ○ decreased tissue emigration - less margination more circulating neutrophils - age in the blood - Seen more in horses - normally have some with higher segmentation - 6 - Can also be seen with myeloproliferative disease e.g. chronic granulocytic leukaemia

Question 37

Describe botyroid nucleus and barr body

Answer 37

Botryoid nucleus - hyperthermia - heat stroke - Cooking of the neutrophils - Can be high fever Barr body - Only found in females as need two X chromosomes - One X chromosome is inactivated and forms the barr body - Present in all female neutrophils but won't see every time due to orientation of nucleus

Question 38

Describe reactive lymphocytes and what are they hard to differentiate between

Answer 38

Larger than normal - (nucleus 2x rbc) Increased basophilic cytoplasm - May have few magenta cytoplasmic granules - Reflect increased antigenic stimulation - Non-specific, often seen in health Hard to differentiate between REACTIVE and NEOPLASTIC

Question 39

What are 2 types of cytoplasmic inclusions and conditions that lead to them

Answer 39

``` 1, erythrophagia 2. sideroleukocyte What conditions might lead to these cells in the blood? 1.. Previous blood transfusion 2. IMHA ```

Question 40

What occurs with Pelger-Huet Anomaly

Answer 40

failure of nuclear segmentation - lots of band and no segmental neutrophils - weird - still functional and NO TOXIC CHANGE

Question 41

What characteristics define an acute inflammatory leukogram and why

Answer 41

Neutrophilia* - Sometimes don't have neutrophilia yet - snapshot in time +/- Toxic change - most important +/- Left shift +/- Monocytosis *most common indicator but not always present Neutrophilia with Inflammation = Release of neutrophils from storage pool +/- release from maturation pool (bands) + increased production (with time)

Question 42

What disease might cause an acute inflammatory leukogram

Answer 42

``` A focus of suppurative inflammation or sepsis e.g. Not heaps of puss - Infected wound - Pneumonia - Pyelonephritis - Tissue damage and necrosis ```

Question 43

List some species variation in response to acute inflammation: cat and dogs, cattle and horses

Answer 43

1) Cats and dogs often have WBC 10-30 x 109/L with inflammation ○ Due to the large storage pool 2) Cattle may only show hyperfibrinogenaemia with no inflammatory leukogram with acute infections ○ Cattle often show transient leukopenia (small storage pool) 3) Horses have moderate leukocytosis and left shift response, often WBC 7-20 x 109/L with acute inflammation

Question 44

At what level of neutrophilia do you start getting worries about leukaemia

Answer 44

50-100 x 109/L | ○ Above 50 start getting worried about leukaemia

Question 45

What characteristcs define a severe acute inflammatory leukogram

Answer 45

“Leukaemoid response” - Marked Neutrophilia - 50-100 x 109/L ○ Above 50 start getting worried about leukaemia - Regenerative left shift - pooling out mature cells ○ Bands - less ○ Metamyelocytes - even less ○ +/- Myelocytes

Question 46

What diseases might cause a severe acute inflammatory leukogram

Answer 46

A focus of intense suppurative inflammation or sepsis - Pneumonia - Pyothorax - Peritonitis - Pyometron - Necrotic tumour (within tumour) ○ DDx: Myeloid Leukaemia, Paraneoplastic syndrome - produce cytokines - increase inflammation

Question 47

what characteristics define overwhelming inflammatory leukogram

Answer 47

Neutropenia and or degenerative left shift (not putting out mainly mature now also immature) - +/- Lymphopenia - don't leave lymph node as quickly - +/- Monocytosis

Question 48

What diseases might cause an overwhelming inflammatory leukogram and what prognosis

Answer 48

A focus of acute sepsis e.g. - pouring pus 1. Intestinal perforation - gut rupture 2. Ruptured Pyometron 3. Endotoxaemia, Gram –ve infections = Marrow unable to meet demand - potential for animal to die is higher DDx: Bone Marrow Disease

Question 49

What characteristics define chronic inflammatory leukogram

Answer 49

- Neutrophilia - mature - +/- Slight regenerative left shift - +/- Lymphocytosis - Monocytosis (high)

Question 50

what diseases might cause chronic inflammatory leukogram

Answer 50

A focus of chronic inflammation e.g. 1. Severe pyoderma 2. Necrotic neoplasia 3. Chronic hepatitis 4. Fungal infections

Question 51

What are the characteristics of a glycocorticoid/stress leukogram and the reason for each

Answer 51

``` Lymphopenia ◦Decreased release from nodes ◦Margination Neutrophilia (Heterophilia in birds) ◦Increased release from storage pool ◦Shift from marginating to circulating pool (express less adhesion factors) Eosinopenia ◦Decreased release from marrow Monocytosis (dogs) ◦Shift from marginating to circulating pool NO LEFT SHIFT OR TOXIC CHANGE ```

Question 52

list the magnitude for the stress leukogram in cats, dogs, equine, bovine

Answer 52

○ Feline 3:1 ○ Canine, equine, bovine 1:1 - Expect mature neutrophilia up to 3x neutrophil upper reference interval in cats - Expect mature neutrophilia up to 2x neutrophil upper reference interval in dogs, horses, cows

Question 53

what is a physiologic leukocytosis and what characteristics define it

Answer 53

``` = Adrenalin/excitement mediated - short duration and generally younger animals - Neutrophilia - Lymphocytosis - +/- Monocytosis - Young animals NO left shift or toxic change ```

Question 54

why do you see a neutrophilia, lymphoctytosis

Answer 54

Neutrophilia •Shift marginating to circulating pool (Increased blood pressure and HR) - very temporally - take two time apart and may go back to normal Lymphocytosis - Shift marginating to circulating pool

Question 55

Granulocytic hypoplasia leukogram what is it, what is it caused by

Answer 55

Persistent Neutropenia with no left shift (>5 days) - bone marrow takes 4-6 days to produce - Caused by bone marrow production problem e.g. ◦Immune mediated neutropenia ◦Drug toxicity - chemotherapy

Question 56

How long should we wait before doing bone marrow evaluation on a neutropenic patient?

Answer 56

5-7 days

Question 57

what is the point at which neutropenia is dangerous

Answer 57

once get below 1.5x10^9 put on antibiotics as risk of getting infection and not being able to fight

Question 58

Hypoadrenocorticism Leukogram (Addisons syndrome) what characteristics define and the electrolyte

Answer 58

- Lack of stress leukogram despite chronic or severe illness - consider this in dogs ○ Could also be excitement - more likely in cats - +/- Lymphocytosis- - +/- Eosinophilia - Hyperkalaemia - Hyponatraemia and hypochloridaemia - Low Na: K ratio (<27:1)

Question 59

where are most plasma proteins produced and which ones aren't

Answer 59

synthesised in the liver | - immunoglobulins are produced by B cells

Question 60

What are the main functions of plasma proteins

Answer 60

``` • Exert colloidal osmotic pressure – maintains intravascular fluid volume • Antibodies (immunoglobulin) • Coagulation factors • Hormones • Enzymes • Help maintain acid-base balance • Transportation of substances ```

Question 61

What are the 2 types of plasma proteins, how much do they compromise of and examples

Answer 61

1) albudmin - 55% of total protein, accounts for 75% of colloid osmotic activity 2) globulins - diverse group divided into 3 main groups 1. alpha 2. beta - complement, IgM, IgA 3. gamma, IgG, C-reactive protein

Question 62

What are the 3 main ways to measure plasma proteins and what do they measure

Answer 62

1. Using plasma via refractometer – Total Solids (an estimate of total protein) 2. Using serum via laboratory analyser – Total Protein + albumin 3. By serum protein electrophoresis - uncommon

Question 63

Refractometer what measures in terms of protein, what tube used, what is the issue and what else does it measure

Answer 63

- using plasma (from whole blood) - use EDTA tube - measured total solids - false increase can be due to glucose, urea, sodium, chloride, lipaemia - fibrinogen is present - used to estimate fibrinogen - heat preipitation to remove solids and leave fibrinogen

Question 64

biochemistry analyser what does it measure and what else can you measure

Answer 64

- measures total protein and albumin - so learn more about proteins globulins are then calculated [Globulins] = [Total Protein] – [Albumin]

Question 65

serum protein electrophoresis (SPE) what is involved and how used

Answer 65

nout a routine test but allows quantification and separation of globulins - patterns help with differential diagnoses

Question 66

What are the two types of abnormal protein concetrations

Answer 66

1. Selective • one is changed in a different direction than the other eg glomerular disease (albumin is lost – hypoalbuminemia) 2. Non-selective • both change in the same direction - hypoalbuminemia and hypoglobulinaemia • A/G ratio remains unchanged eg haemorrhage (both lost – panhypoproteinemia)

Question 67

Give a cause of increased TS and decrease TS

Answer 67

Increased TS = hyperproteinaemia - dehydration Decreased TS = hypoproteinaemia - haemorrhage

Question 68

List 3 reasons for hyperglobulinaemia

Answer 68

1) Dehydration – relative increase due to plasma water loss 2) Inflammation – absolute increase due to production of positive acute phase proteins and immunoglobulins 3) Less commonly see with B-lymphocyte neoplasia - use serum protein electrophoresis to determine eg multiple myeloma or less commonly B-cell lymphoma

Question 69

What are the characteristics in a serum protein electrophoresis for inflammatory disease and neoplasia

Answer 69

inflammatory - polyclonal gammopathy = wide-based immunoglobulin peak on electrophoresis - more than one cell line increased neoplasa - monoclonal gammopathy = narrow-based immunoglobulin peak on electrophoresis

Question 70

What are the 3 main mechanism for hypoalbuminaemia and give 2 examples

Answer 70

1) increased albumin loss - haemorrhage, gastrointestinal.renal loss 2) decreased albumin production - hepatic insufficiency, inflammation, malabsorption 3) haemodilution - uncommon

Question 71

List clinical effects of hypoalbuminaemia and at what concentration does that occur

Answer 71

``` When plasma albumin loss is marked ie < 15 g/L: • Colloid osmotic pressure decreases • Can lead to vascular fluid loss into tissues: - Peritoneal effusion (ascites) - Pleural effusion - Pericardial effusion - Pulmonary oedema - Submandibular oedema ```

Question 72

What are the 4 main mechanisms of hypoglobulinaemia and examples

Answer 72

1. • Increased loss - haemorrhage, GIT, skin, effusions 2. • Decreased production - malabsorption, maldigestion, malnutrition 3. • Failure of passive transfer - inadequate colostrum intake in the newborn - measure immunoglobulins • horses and cattle 4. • Severe combined immunodeficiency syndrome (SCID) - rare - Horses such as arabs are pre-disposed as well as some dog breeds - jack Russell

Question 73

List 4 positive acute phase proteins

Answer 73

1) fibrinogen - moderate APP, rises slowly, readily available 2) haptoglobin (cattle) 3) serum amyloid A 4) C-reactive protein - dogs Bottom 3 are major and rapidly rise and also rapidly decrease resulting in them being very sensitive

Question 74

List the main negative APP ad what is the APP testing used for

Answer 74

- decreases with inflammation Albumin - can take several days to decrease due to longer half-life Testing - monitor for post-operative infection - cheap way, should follow normal increase-decrease pattern

Question 75

What are the 2 main causes of hyperfibrinogenaemia

Answer 75

``` 1. Inflammation • positive acute phase protein § useful in horses and cattle § may increase before leukogram changes 2. Dehydration • relative increase due to plasma water loss ```

Question 76

what are the 2 main causes for hypofibrinogenaemia

Answer 76

1. Decreased synthesis - reduced functional hepatic mass • more than 70-80% loss of function 2. Increased consumption - intravascular coagulation ie DIC

Question 77

when are you clinical suspicious of bone marrow disease

Answer 77

haematologic abnormalities are present persistent and not readily explained such as 1. decrease in blood cell line or increase, atypical immature cells, hypercalcaemia

Question 78

when are you clinical suspicious of bone marrow disease and list the 6 abnormalities

Answer 78

haematologic abnormalities are present persistent and not readily explained 1. Decrease in a blood cell line 2. Severe increase in a blood cell line 3. Atypical or immature cells 4. Marked hyperproteinemia 5. Hypercalcaemia

Question 79

What is the most common indicators of bone marrow disease and give 3 examples

Answer 79

Decreased cell numbers can be one, two or all three - pancytopenia 1. persistent non-regenerative anemia - no polychromasia 2. persistent neutropaenia - no left shift or toxic change 3. thrombocytopaenia - no large or giant platelets, run coag panel to rule out DIC

Question 80

List 5 causes of decreased cell numbers

Answer 80

1) infectious - parvovirus, FeLV 2) toxins - bracken fern - ruminants 3) immune-mediated disease - IMHA 4) endocrine disease - hypothyroidism 5) neoplasia - replace bone marrow

Question 81

List 3 examples of what cause severe increase in cell numbers

Answer 81

1. Erythrocytosis, rubricytosis • no evidence of splenic contraction, dehydration, hypoxia, renal disease 2. Leukocytosis • no evidence of inflammation 3. Thrombocytosis • no evidence of Fe deficiency, inflammation

Question 82

Differences between leukaemia and lymphoma

Answer 82

1. Leukaemia • neoplastic haematopoietic cells originate in bone marrow but often seen in circulation ○ Could be red blood cell, platelet, neutrophil ○ acute vs chronic ○ lymphoid vs myeloid (all cell lines except lymphoid) 2. Lymphoma • neoplastic lymphocytes originate in solid tissue lymphoid tissue outside the bone marrow eg lymph node, spleen, liver, intestine, skin

Question 83

How to differentiate between lymphoma and leukaemia

Answer 83

Look for original site of lymphoma - lymph nodes huge! Happy dog as lymph nodes not painful Chemotherapy can increase quality of life for 1-2years Leukaemia dog - very sick, dead within a couple of weeks

Question 84

What are 2 types of atypical cells and what do they indicate

Answer 84

indicate bone marrow disease 1. immature cells - abscence of regnerative response 2. abnormal cell

Question 85

Marked hyperproteinaemia what does it support bone marrow evaluation for

Answer 85

1. Lymphoid neoplasia • B-cell chronic lymphocytic lymphoma • Multiple myeloma (plasma cell neoplasia) 2. Systemic fungal and protozoal infections - can see in bone marrow aspirates • Histoplasmosis, Leishmaniasis ○ both exotic to Australian domestic animals

Question 86

hypercalcemia what 3 main neoplasms lead to this

Answer 86

1. lymphoid neoplasms - production of PTH-related protein 2. multiple myeloma - localised osteolysis 3. metastatic neoplasia (eg histiocytic sarcoma) - production of PTH-rp or VitD

Question 87

what are the two main bone marrow collection and what are they good for

Answer 87

Simultaneous evaluation of bone marrow cytology (aspirates - great for cell morphology)) and histology (core biopsy - evaluate architecture) is recommended

Question 88

What are the 4 site selections for bone marrow

Answer 88

``` 1. Pelvis • iliac crest; medium/large size dogs 2. Proximal femur • trochanteric fossa; cats and small dogs 3. Proximal humerus - go to site • common site especially in obese animals 4. Sternum • site of choice for horses ```

Question 89

When do you need to make the smears for bone marrow collection and what must you submit

Answer 89

- smears are made immediately after collection - submit several unstained smears - must be submitted with an EDTA blood sample within 24 hours

Question 90

multiple myeloma what type of neoplasm and what characteristics present

Answer 90

- plasma cell neoplasia - malignant - specialised B-lymphocyte Diagnostic 1. neoplastic plasma cell in bone marrow 2. monoclonal gammopathy 3) oesteolytic lesions 4) light chain proetinuria

Question 91

List the lymph nodes associated area of drainage 1) Axillary lymph node 2) Mediastinal lymph node 3) Mesenteric lymph node - intestine 4) Popliteal lymph node 5) Prescapular lymph nodes 6) Retrophoryngeal lymph node 7) Submandibular lymph node

Answer 91

1) distal forelimb 2) lungs 3) intestine 4) distal hind limb 5) shoulder 6) pharynx 7) mandible

Question 92

what is different about total calcium in the blood and what effects this

Answer 92

70% bound to albumin (not active form) so if get increase in albumin will get increase in calcium If albumin is high due to many reasons such as dehydration

Question 93

What interferes with ADH

Answer 93

- Lack of ADH production or issue with kidneys response to ADH (determine final concentration of urine - can draw in huge amount of water) - Corticosteroids, toxins released by bacterial infections (pyometra), hypercalcaemia - This can be due to hypercalcaemia - also causes alterations in renal blood flow - decreased filtration rate, renal mineralisation overtime - leads to full renal problems