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POD > 2.1 Red Blood Cells > Flashcards

2.1 Red Blood Cells Flashcards

1
Q

What are cytokines? Which ones are important for RBCs?

A

-Cytokines are small proteins that are crucial in controlling the growth and activity of other immune system cells and blood cells.
o Erythropoietin (Epo)
o Interleukins
o Inhibitory cytokines

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2
Q

What is the stimulus and source of erythropoietin?

A

stimulus: hypoxia
source: kidney

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3
Q

how long does erythropoiesis/ maturation take?

A

(5-) 7 days

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4
Q

what are the cellular compartments of bone marrow relevant hemopoiesis? how do cells progress between these and where do they go from here?

A

stem cell compartment >
progenitor cell compartment >
precursor cell compartment >
peripheral blood >
peripheral tissues

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5
Q

what is the progression of cell types in erythropoiesis? At what stage do cells stop dividing and only mature?

A

rubriblast > prorubricyte > rubricyte > metarubricyte > reticulocyte > erythrocyte

division stops around the rubricyte stage
there are other cell names that could be added to this list

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6
Q

what is the rbc lifespan of cows, horses, dogs, and cats?

A

cow: 160d
horse: 145d
dog: 110d
cat: 70d

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7
Q

Where are red blood cells phagocyosed mainly, and by what?

A

macrophages remove RBCs in the spleen

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8
Q

what species is it more common to see anisocytosis?

A

bovine

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9
Q

what species has pale staining platelets?

A

horses

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10
Q

In what domestic species is it normal for RBCs to have central pallor?

A

dogs

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11
Q

How do we prepare blood for a CBC and what is measured?

A

-Store blood in lavender top tube with anti-coagulant (EDTA)
RBC indices:
-MCV: average size of RBCs; microcytic, normocytic, macrocytic
-MCH: hemoglobin per RBC; uncommonly used
-MCHC: hemoglobin/ unit volume; hypochromic (increased central pallor - iron limitation), normochromic, hyperchromic
-rubricytes: immature RBC

Thrombocyte indices:
-MPV: average size of platelets; shift platelets are large and immature

Leukocyte differentials
Anisocytosis

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12
Q

What can we use to detect total plasma protein?

A

hematocrit tube > refractometer

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13
Q

what do different colours of hematocrit tubes signify?

A

normal - clear
lipidemia - white
hemoglobinemia - red. free hemoglobin present (more dominant than bilirubin). likely due to IV hemolysis
bilirubinemia - yellow. product of RBC breakdown, could be due to EV hemolytic disease or liver disease. Horses naturally have more bilirubin in their plasma.

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14
Q

what part of a blood smear should we look at to see parasites?

A

feathered edge

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15
Q

what might give us an artificially low platelet count from a machine? What species is this important for?

A

platelet clumps at the feathered edge. common in cats

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16
Q

what is auto-agglutination? What should we consider when we see it?

A

-Antigen-antibody complexes on the RBC surface cross-linking/binding to each other
-Presents in a test tube as stippling of red cells, like bunches of grapes on the smear
-Consider: immune mediated pathogenesis

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17
Q

what is rouleaux? When, where do we see it and what does it mean?

A

-line of connected
-Usually an artifact – especially in horses and cats
-Uncommon in dogs and ruminants
>When seen in dogs it may indicate that there is an increase in proteins – inflammatory globulins, APPs. Look at biochem panel to assess.

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18
Q

what is the saline dilution test and what is it used for?

A

-Take a drop of blood and 4 drops of saline, then look at it under a microscope
Rouleaux → dispersal of RBCs
Agglutination → persistent RBC clumps

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19
Q

what is polychromasia and when do we see it?

A

-Due to increased presence of darker staining immature RBCs – polychromatophils
-Bigger, bluer cells – Wright’s stain
-Released by bone marrow in response to decreased oxygen carrying capacity
-Limited in healthy animals
-Consider: regenerative bone marrow response
-not really seen in horse regenerative response < cow < dogs < cats

20
Q

what are reticulocytes and when do we see them?

A

-Bigger cells with residual RNA clumping in a reticular pattern
-Same as polychromatophils but stained with New Methylene Blue & Wright’s
-Consider: regenerative bone marrow response

21
Q

what is hypochromasia? When do we see it?

A

-More challenging to identify in dogs
-Consider: iron deficiency
i.e., dog with chronic blood loss entering stage of iron deficiency, impairing RBC production, causing pale RBCs to be released from the bone marrow

22
Q

what is basophilic stippling? When might we see it?

A

with wright’s stain
-consider Pb toxicity

23
Q

what are poikilocytes? When do we see them?

A

-General change in RBC morphology (size/shape) – many types
-Commonly seen in fragile iron deficient erythrocytes

24
Q

what is crenation and when do we see it?

A

-Spikey projections around RBC due to slow drying
-Could hide other features of the cell
-Could be pathologic but usually artifact

25
Q

what are acanthocytes and when do we see them?

A

-Long, irregular projections on RBCs due to abnormal composition of RBC membranes (classically have little ‘beads’ on the end of projections)
-Consider: liver/spleen disease when abundant

26
Q

what are spherocytes and when do we see them? How are they created?

A

-Small dense cell with no central pallor (easier to identify in dogs)
-Aren’t counted in RDW because they have the same volume as RBCs
-Consider: Immune Mediated Hemolytic Anemia (IMHA) or transfused red cells
-Created when macrophages selectively target the antibody-antigen complex on the RBC, after removal of that portion of the membrane in the spleen, the cell reseals more densely > less Hb
-During transfusion, blood gets added from a bag that could’ve caused morphologic changes due to the fluid or anticoagulant

27
Q

what is a schistocyte and when do we see them?

A

Fragmentation of RBCs
-Caused by shearing of RBCs by fibrin in circulation
-Form of hemolysis
-Consider: Disseminated Intravascular Coagulation (DIC)

28
Q

what is a microcyte and when might we see one?

A

-Small RBCs
-Consider: Disseminated Intravascular Coagulation (DIC)

29
Q

what types of inclusions can we see in RBCs?

A

-parasites
-bacteria
-heinz bodies
-howell-jolly bodies
-nucleated RBCs

30
Q

what do bacteria look like in RBCs? What test should we follow up with if we detect this?

A

tiny blue structures on the surface or edge of the cell
-can be hard to detect because they often look like stain precipitate
-follow up with a PCR test

31
Q

what are heinz bodies? How can we best see them? When do they appear?

A

-Single projection on the periphery of an RBC
>Areas of denatured hemoglobin
>Better seen with NMB stain
-Somewhat normal in cats because of their unique spleen
>Concerning in anemic cats
-Consider: oxidative damage/hemolysis (and anemia)
>i.e., drugs, chemicals, toxins, acetaminophen in cats, onion/garlic in dogs, Zn toxicity from coins, Cu toxicity in sheep

32
Q

What are Howell-Jolly bodies? When do we see them and what do they mean?

A

-Nuclear remnant that was not ejected during differentiation
-Usually removed by the spleen, but can be normal in cats
-Non-specific pathologic indicator

33
Q

what are rubricytes? Where should they be? When might we find them in circulation?

A

-Immature, nucleated RBCs that should be in bone marrow
-Present in certain disease circumstances
>i.e., extramedullary hematopoiesis, 1˚ bone marrow disease

34
Q

What are target cells? What do they mean?

A

-A blip of hemoglobin in the center of a canine RBC
-Consider: liver disease/neoplasia when abundant
>Otherwise, non-specific

35
Q

What are eccentrocytes? When might we see them?

A

-RBC with peripheral white sections
-Clearing of hemoglobin on the periphery of the cell
-Consider: oxidative damage

36
Q

What are ghost RBCs? When might we see them? What else might we see along with them?

A

-White round cell marks
-Consider: intravascular hemolysis
>Plasma would likely be red due to free Hb (hemoglobinemia)

37
Q

what are dacrocytes and what should we consider if we see them?

A

-Tear drop shaped cells
-Consider: myelofibrosis and other BM issues
>Check the bone marrow!

38
Q

when do we see protein crescents on a blood smear?

A

if there is increased protein in the blood

39
Q

Which values will be low in a case of anemia?

A

RBC: presents on blood smear as more space between the RBCs
Hgb
HCT: used to classify severity

40
Q

What RBC issues can anemia be due to?

A
  1. Decreased RBC production
    -At the level of the BM
    -Note that current cells will remain for the duration of their lifespan
  2. Increased RBC loss
    -Cells removed from circulation by hemorrhage or hemolysis
41
Q

what are seven possible things that could lead to anemia?

A
  1. renal failure
  2. hemolysis
  3. endocrine
  4. neoplasia
  5. inflammation
  6. blood loss
  7. iron deficiency
42
Q

How do we assess an anemia? What tools can we use to gather evidence?

A

History – acute or chronic?
PE
CBC
Reticulocyte count – regen.?
Total serum/plasma protein

43
Q

How do we characterize an anemia?

A
  1. Severity
    -Defining severity is subjective and comes with experience based on HCT
    >Sometimes based on other analytes too!
  2. MCV
  3. MCHC
  4. Regenerative/non-regenerative
44
Q

Broadly, what are the possible causes of regenerative anemia? How will these show in protein levels?

A

hemolysis or internal hemorrhage - normal or high protein
>note that protein can also be influenced by inflammation and dehydration (appear higher)

external hemorrhage - low protein

45
Q

broadly, what are the possible causes of non-regenerative anemia? What are the characteristics of each?

A

marrow disorder
1˚
-Disease arising in the bone marrow itself
-Directly involved in the disease process
-Multiple cytopenias
2˚
-A systemic disease impacting RBC production in the BM
-Selective red cell depression

46
Q

what are the tell-tale signs of a regenerative anemia?

A

-Increased polychromasia/reticulocytes
>increased anisocytosis; RDW
>increased MCV; macrocytosis
>decreased MCHC; hypochromasia

-Increased neutrophils, platelets
>Can have leukopenias still

-Rubricytes cannot be the sole indicator of regenerative anemia
>If there is no polychromasia, another explanation is required
>Increased rubricyte count requires a corrected WBC count due to it counting nucleated cells
>WBC – rubricyte count = corrected WBC

47
Q

what are the tell-tale signs of hemorrhage? What differences might we see between single site vs multiple site?

A
  1. Anemia
  2. Hypoproteinemia (with sufficient external blood loss)
  3. Reticulocytosis – bone marrow shouldn’t be impaired
  4. Hypochromia (if chronic and external)
    >Due to loss of iron over time, leading to decreased hemoglobin

Single sites = local problems
-i.e., trauma, neoplasm
Multiple sites = platelet and clotting factor issues
-i.e., GI bleeding, blood loss in urine, hematomas

POD (21 decks)

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