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Platelet Response in Disease, PVM
Final Exam Questions
38
Veterinary Medicine
Graduate
11/29/2011

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Cards

Term

Four main functions of platelets?

Definition
  1. Maintain vascular integrity by sealing endothelial defects
  2. Helping to stop bleeding- form platelet plug
  3. Contribute to membrane lipid procoagulant activity- secondary hemostasis (coagulation)
  4. Promote vascular healing through the release of platelet derived growth factors (PDGF)
Term
Platelets play a role in inflammation through the release of soluble mediators such as?
Definition
Serotonin and various modulators of neutrophil function
Term

Platelets are produced in the bone marrow from a precursor cell called a?

 

This occurs in a process called?

Definition

Megakaryocyte

 

Cytoplasmic Demarcation

Term
Differentiation of megakaryocytes from stem cells is regulated by what hormone?
Definition
Thrombopoietin
Term

Circulating thrombopoietin levels apper to be inversely correlated with platelet levels

 

True/False?

Definition
True
Term
In dogs, what is the estimated amout of platelets in systemic circulation?
Definition

2/3 to 3/4

 

There is free exchange between the splenic and circulating pools

Term
Circulating platelets have an average circulating lifespan of how many days?
Definition

3 to 7

 

Old platelets are remeoved from the body through phagocytosis by macrophages

Term
By far, the most common and most important platelet abnormality is what clinical finding?
Definition
Reduced platelet count or thrombocytopenia
Term
What are the two most important tests for evaluating and assesing platelets?
Definition
Platelet count and evaluation of the blood film for adequate platelet numbers
Term

Automated platelet counts are reliable for dogs but not for most other domestic specis.

 

True/False?

Definition

True

 

Platelets from other specis are prone to clump, which would alter the automated platelet counter

 

When mild to moderate thrombocytopenia is noted in a dog, it should be flaged as suspect and recounted

Term
Why are automated platelet conters particularly unrelialbe in cats?
Definition
Because of the great variability in platelet size in addition to the tendency of cat platelets to aggregate
Term
When scanning a blood film to estimate the relative platelet number, how many platelets should a monolayer contain under oil immersion (100x)
Definition
Abut 8 to 12 platelets
Term

BMBT stands for what?

 

What is it used for?

 

It is only a value when platelet counts are above what level per ul?

Definition

Buccal Mucosal Bleeding Time

 

Test to determine adequacy of endothelial cell and platelet function.  More sensitive for platelet function.

 

75,000/ ul

Term

What is the process for performing the BMBT test?

 

What is the reference range for a dogs and cat for BMBT time?

Definition

A "bleeding time device" that creates a standardized incision is utilized.  The test is performed on the patients upper lip buccal mucosa.  The patient is non-anesthetized.  Blood seeps from the incision, and a paper towel is used to soak it up without blocking the incision.  The time from incision to cessation is the BMBT.

 

1.8 to 4.2 minutes

Term

MPV is usually proportional to the platlet number?

 

True/False?

Definition
False.  It is inversly proportional to platelet number
Term
What is the normal MPV for a dog and cat?
Definition

Dog:  6 to 10 femtoliters

 

Cat:  12 to 18 femtoliters

Term

Elevation in MPV is suggestive of active (responsive) platelet production.  Artifactual increases occure with EDTA, when platelets are refrigerated, or if there is delayed exposure to anticoagulant. 

 

MPV is best measured from blood collected into what, and stored at what temperature?

Definition
Citrate and stored at 370C until analyzed
Term
When would it be probable to see a decreased MPV?
Definition
Very early in the course of immune mediated thrombocytopenia and with bone marrow failure
Term

PDW stands for what?

 

 

Definition

Platelet Distrubution Width

 

An index of variation in platelet size, used to determine the presence of abnormally sized platelets

Term
The clinical hallmark of thrombocytopenia is the occurrence of what?
Definition

Petechiae- capillary or postcapillary venule hemorrhage

 

Coalescing petechiae are called purpura

Term
What are the four mechanisms resulting in thrombocytopenia?
Definition
  1. Sequestration
  2. Hypoproliferation
  3. Consumption
  4. Destruction
Term
Sequestration is associated with what two conditions?
Definition
Hypersplenism and splenomegaly
Term
What are some signs seen with a hypoproliferative platelet disorder?
Definition
  1. Very low peripheral platelet counts (<50,000/ul)
  2. Bone marrows are nearly devoid of megakaryocytes
Term
What are the 5 possible causes to a hypoproliferative thrombocytopenia?
Definition
  1. Infections- Ehrlichia, FIV, FeLV
  2. Drugs and Chemicals- NSAIDs, estrogen, sulfadiazine
  3. Vaccines
  4. Toxins
  5. Immune-mediated marrow disease
Term

Consumptive thrombocytopenias are seen with DIC and occur secondary to severe systemic inflammation.

 

What are the clinical features that are commonly seen with this disorder?

Definition

Peripheral thrombocytopenias range (50,000 to 150,000/ul)

 

Bone marrow megakaryocytes are normal in number

 

In dogs, often increased numbers of red cell schizocytes

Term
DIC is confirmed with a DIC panel.  What 5 tests does the panel include?
Definition
  1. Prothrombin time (PT)
  2. Activated partial thromboplastin time (APTT)
  3. Fibrin split products
  4. Platelet count
  5. Fibrinogen levels

If any three of the five are abnormal, DIC is considered to be present

Term
What is the difference between primary and secondary immune-mediated thrombocytopenia?
Definition

Primary- idiopathic anti-platelet antibodies which cause accelerated destruction

 

Secondary- clinically identical to primary but occurs in association with any of a number of underlying disorders such as systemic immune disease, neoplasia, infectious disease, and vaccination.

Term
What does the platelet count and bone marrow look like with a destruction thrombocytopenia?
Definition
  1. Very low peripheral platelet counts (<50,000/ul)
  2. Normal to increased numbers of bone marrow megakaryocytes

In some cases, antibodies can be directed against platelet precursors and this condition can't be differentiated from a hypoproliferative disorder.

Term
What are the 3 categories of throbocytosis?
Definition
  1. Primary or essential
  2. Secondary
  3. Physiological
Term

What are the caracteristics of each throbocytosis category?

Primary, secondary, and physiological

Definition

Primary- characterized by a persistent thrombocytosis (>100,000/ul), primarily a disorder of dogs presenting with a bleeding thrombosis.  May present with either regenerative or non-regenerative anemia

 

Secondary- Transiently increased platelet counts in patients with other primary disorders such as blood loss, gastrointestinal disease, fractures, immune-mediated disorders and others

 

Physiological- Increased mobilization of platelets from splenic and pulmonary pools, occurs as a result of exercise or epinephrine injection

Term
What is the definition of thrombocytopathies?
Definition
Conditions where platelet counts are near normal (>100,000/ul) but platelet function is impaired
Term
Out of all the tests, which one is usually an abnormal clinical finding with a thrombocytopathy
Definition

Near normal platelet counts, normal PT APTT, normal fibrin split products, and normal fibrinogen levels.

 

The BMBT is prolonged

Term
Thrombocytopathies may be aquired or inherited.  What are some causes of acquired thrombocytopathy?
Definition
  1. Uremia
  2. Infectious (FeLV, Ehrlichia)
  3. Snakebite
  4. Hepatic disease
  5. Various neoplasms
  6. Drugs (NSAIDs, antibiotics, calcium channel blockers, dextrans, and colloids)
Term
What are the different types of inherited thrombocytopathies?
Definition
  1. Von Willebrand's Disease (vWd)- most important
  2. Basset Hound thrombopathia
  3. Canine thrombasthenic thrombopathia of Otterhounds and Great Pyrenees
  4. Spitz thrombopathia
Term
What are the characteristics of the three categories of Von Willebrand's disease?
Definition
  • Type 1: 
    • observed in many canine breeds and cats, mild bleeding tendency
  • Type 2: 
    • German Shorthair Pointers and Wirehaired Pointers, moderate bleeding tendency
  • Type 3: 
    • Scottish Terriers, Chesapeake Bay Retrievers, and Shetland Sheep Dogs, moderate bleeding tendency. vWf is usually 0% of normal
Term
When is definitive diagnosis established with vWd?
Definition
When species specific vWf is reduced to less that 50% of normal.
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