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clinical pathology > body fluid cytology > Flashcards

body fluid cytology Flashcards

1
Q

what is an effusion?

A

accumulatio of fluid in the pleural, peritoneal or pericardial space

due to increased entry or decreased removal of fluid

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2
Q

clinical signs

A

abdominal pain/distension-fluid wave

dyspnea

muffled heart and/or lung sounds

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3
Q

5 major mechanisms of effusions

A

increased vascular hydrostatis pressure

decreased plasma oncotic pressure

increased vascula permeability

decreased lymphatic drainage

damage to viscera

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4
Q

sample handling and preparation

A

always prepare a slide-eliminates in vitro artifacts

purple top-preserves cellular detail, TP, TNCC

Red top-culture, chem analysis-crea, bili

blood smear technique or line smear technique

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5
Q

staining

A

dry slide quickly

prepare several smears

in house Diff-Quik type stain

stain maintenance is important!

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6
Q

Fluid analysis components

A

gross appearance (color and turbidity)

TP

total nucleated cell count

cytologic examination

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7
Q

abnormal colors

A

pink to red-blood

yellow-urine

green-bile

white-chylous effusion

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8
Q

turbidity

A

clear-low cell conc

cloudy-high cellularity or lipid

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9
Q

TP measurement

A

refractometer

spin first if cloudy

interference with lipema, hemolysis and icterus

TP breakpoints: <2.5, 2.5-3.0, >3.0

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10
Q

Total nucleated cell count

A

automated

in house-hemacytometer

verify counts by smear evaluation

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11
Q

cytologic evaluation

A

large mononuclear cells/macrophages

mesothelial cells

lymphocytes

neutrophils

RBCs

eosinophils, mast cells

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12
Q

mesothelial cells

A

can occur in large rafts or individually

characteristic brush-like eosinophillic border

often appear reactive

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13
Q

transudate

A

normal fluid-scant in SAM, more in LAM

clear and colorless

TP: <2.5 g/dl

cell count: <1,000 cell/ul SAM

<5,000 cell/ul LAM

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14
Q

transudate cytology

A

SAM-large mononuclear cell, few non-degenerate neutrophils, small lymphs, RBCs, reactive mesothelial cells

LAM-many more neutrophils

chronicity-fluid irritating-increased neutrophils, more reactive mesothelial cells

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15
Q

causes of transudate

A

increased hydrostatic pressure-portal hypertension

decreased oncotic pressure-low protein-hepatic insufficiency, PLE, PLN

decrease clearance of fluid-early heart failure, lymphatic obstruction

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16
Q

modified transudate

A

light yellow/clear to slight cloudy

TP: >2.5 g/dl

Cell count: 1,000-5,000 cells/ul SAM

5,000-10,000 cells/ul LAM

cytologic eval: variable/similar to transudate, % of neutrophils and small lymphs may increase

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17
Q

modified transudate causes

A

increased vascular permeability

lymphatic/vascular obstruction

mild inflammation

cardiac insufficiency, neoplasia, thrombosis, acute organ torsion, diaphragmatic hernia

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18
Q

7 yo FS beagle

hx of heart murmur, presented for collapsing episodes, lethargy and distended abdomen

abd fluid: Straw, slightly turbid, TP: 2.9 g/dl, TNCC: 1,022 cells/ul, 77% non-deg neutro, 23% large mononuclear cells

Classification and cause?

A

modified transudate

cardiac insufficiency

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19
Q

Exudate

A

color: apricot/tan/reddish/orange
turbidity: cloudy/chunky

TP: >3.0 g/dl

Cell count: >5,000 cells/ul SAM, >10,000 cells/ul LAM

20
Q

Exudate cytologic eval

A

characterized by degree of infl, predominate cell type, septic vs non-septic

predominate cell type varies: often neutro, mixed, macs

septic vs non-septic: degenerate neutro (swollen pale nuclei), always look for etiologic agents, culture often needed

21
Q

exudate causes

A

increased capillary permeability

often secondary to infl

chemotactic stimuli

sterile irritants

septic:infectious agents

non-septic: infla of local organs (pancreatitis), sterile irritants (bile), neoplasia

22
Q

Sandy: 5 yo FS yellow lab

Presented for 2 week hx of lethargy, muffled heart and lung sounds, rads: pleural fluid

A
23
Q

Hemorrhagic effusion

A

pink to red/cloudy

TP: >3.0 g/dl

TNN: variable but usually >1,000 cell/ul

Cyto: nucleated cells are similar to peripheral blood

24
Q

hemorrhagic effusion: contamination vs hemorrhage

A

erthrophagocytosis

red cell break down products-hemosiderin, hematoidin

may not see peracute hemorrhage

PCV will be 10-25% that of blood, no platelet, no clotting

25
Q

hemorrhagic effusion causes

A

trauma

coagulopathies

neoplasia-eg hemangiosarcoma

26
Q

Barrett: 5 yo MN greyhound

hx of v, d, anorexia, lethargy, difficulty breathing

PE revealed muffled lung and heart sounds

A
27
Q

billious effusion

A

yellow, green brown/opaque

TP: >3.0 g/dl

TNCC: often >5,000 cells/ul

28
Q

bilious effusion cyto

A

mixed infl cells-often exudate, primarily neutro and large mononuclear cells

presence of yellow, green, blue-black material-in background, in cytoplasma of neutro and large mononuclear cells

bilirubin conc: Serum vs fluid

29
Q

bilious effusion cuaess

A

rupture/leakage from biliary tract

trauma

cholelithiasis

cholecysitis/cholangitis

bile duct carcinoma

30
Q

uroabdomen

A

fluid lacks distinct char

TP <3.0 g/dl often <2.5 g/dl

TNCC often <4,000 cell/ul

may become inflamed with time

non-septic exudate, septic exudate if associated with UTI

31
Q

Uroabdomen cytologic eval

A

varying number of inflammatory cells-neutrophils, large mononuclear cells

dx: creat conc (Fluid>serum)

distinct patterns of electrolyte change-hyperkalemia, hyponatremia

32
Q

uroabdomen-causes

A

trauma

urolithiasis

neoplasia of urinary tract

33
Q

Chylous Effusion

A

most often occurs in thoracic cavity

white to pink and opaque, usually does not clear after centrifugation

TP and TNCC-similar to modified transudate or exudate

34
Q

chylous effusion cyto eval

A

small lymps predominate

% neutrophils and large mononuclear cells increase with chronicity

may see fine lipid vacuoles in background

triglyceride conc: serum vs fluid

35
Q

chylous effusion causes

A

idiopathic

cardiac insufficiency

lympathic/thoracic duct obstruction

thoracic duct rupture

36
Q

Pete: 12 yo MN mixed breed dog

presented for respiratory distress

thoracic fluid: White/milky

TP: 4.6 g/dl

TNCC: 1,820 cells/ul

64% lymph, 15% mac, 20% neutro

Triglycerides: 1642 mg/dl

A

chylous effusion,

mediastinal mass

37
Q

neoplastic effusion

A

light yellow to apricot/clear to cloudy

TP: >2.5 g/dl

TNCC: variable

38
Q

neoplastic effusion cyto eval

A

presence of neoplastic cells

+/- inflammation and hemorrhage

must distinguish from reactive mesothelial cells!

39
Q

neoplastic effusion causes

A

lymphoma

carcinoma

mesothelioma

40
Q

Dixie: 9 yo Missouri Fox trotter mare

hx of progressive anorexia, lethargy, mildly increased respiratory effort

abd fluid: yellow/slightly turbid

TP: 5.2 g/dl

TNCC: 5,010 cells/ul

cyto: markedly atypical epitheloid cells, marked anisocytosis & anisokaryosis, nuclear to cytoplasmic ratio is often high, rare mitotic figures and signet ring cells

A

neoplastic effusion

41
Q

FIP effusion

A

straw to golden color, tenacious, often thin fibrin strands suspended

TP: >4.0 g/dl

TNCC: variable

non-septic exudate or high protein modified transudate

42
Q

FIP effusion cyto eval

A

non-degenerate neutro, large mononuclear cells, small lymphs

often has granular pink (protein) background

43
Q

Stella 3 yo FS Weimaraner

hx of Grade 1 mast cell tumor removed 3 m ago and treated with Mastinib

presented for lethargy, vomiting, and distended painful abdomen

chem: Protein: <2.5 g/dl, alb: <1.5 g/dl

abdominal fluid: colorless/slightly turbid, TP: <2.5 g/dl, TNCC: 690 cells/ul

75% non-degenerate neutro, 22% mac, 3% lymph

A

transudate, chronic

likely due to liver insufficiency or PLN/PLE

idiosyncratic reaction to Mastinib

44
Q

Cody 4 yo MN GSD

hx of chronic d and distended abdomen

WBC COunt 25.18 (3.88-14.57)

Seg neutro: 22.41 (2.1-11.2)

Bands: 2.01 (0.0 -0.13)

Lymph: 0.5 (0.78-3.36)

mono: 0.25 (0-1.2)

Eos: 0 (0-1.2)

WBC morph: 2+ toxic change

abdominal fluid: slightly pinkt/turbid, TP: 5.6 g/dl, TNCC: 49,070 cells/ul, 85% mildly degenerate neutrophils, 16% large mononuclear

A

leukocytosis, acute inflammatory/steroid leukogram

marked neutrophilic exudate

culture

hepatocellular carcinoma

45
Q

OPal 16 yo Friesian mare with colic

abd fluid: yellow/slightlly turbid

TP: <2.5 g/dl

TNCC: 1,640 cells/ul

89% large mononuclear cells, 30% non-degenerate neutrophils, 1% small mononuclear cells

A

transudate

46
Q

Susannah 2 yo SF DSH

adopted 3 months ago after being held as a stray in a vet clinic, decreased appetite for a week, progressively more lethargic for past 3 days, increased drinking

PE: thin with unkempt haircoat, Icteric MM, Febrile, Distended abdomen, FeLV negative

WBC count: 17.3 (4.5-15.7)

Seg neutro: 15.7 (2.1-13.1)

Bands: 0.5 (0.0-0.3)

Lymph: 0.9 (1.5-7.0)

Mono: 0.2 (0-0.9)

eos: 0 (0-1.9)

WBC morph: slightly toxic neutrophils

HCT: 20%

RBC count: 4.6 (5-10)

Hgb: 6.4 (8-15)

MCV: 42.4 (39-55)

MCHC: 32 (31-35)

RBC morph: normal

Plt: 273 (183-643)

Plasma: icteric

TP: 7.7 (5.7-7.5)

abdominal fluid: pre spin: dark yellow, hazy; post spin: dark yellow, clear

TP: 6.7

TNCC: 2,300

Cyto eval: 75% non-degenerate neutro, 14% small lymphs, 11% large mononuclear cells, no etiologic agents, background thick and eosinophilic

A

FIP

leukocytosis with mature and immature neutrophilia, lymphopenia, toxic neutrophils

moderate normocytic, normochromic non-regenerative anemia

47
Q

lady: 13 yo FS American Eskimo dog

PE: distended abdomen with fluid wave, febrile, tachycardia, large amount of fluid is collected during abdominocentesis

WBC Count: 6.8 (6-17)

Seg neutro: 4.6 (3.0-11.0)

band neutro: 1.2 (0-0.3)

lymph: 0.7 (1-4.8)
mono: 0.2 (0.2-1.4)
eos: 0.1 (0-1.3)

WBC morph: mild toxic change in neutrophils

HCT: 44%

RBC count: 6.3 (5.5-8.5)

Hgb: 14.7 (12-18)

MCV: 71.9 (66-77)

MCHC: 33.4 (31-34)

RBC: normal

Plasma: normal

PLT: 127 (250-450)

A

clinical pathology (8 decks)

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