body fluid cytology Flashcards
what is an effusion?
accumulatio of fluid in the pleural, peritoneal or pericardial space
due to increased entry or decreased removal of fluid
clinical signs
abdominal pain/distension-fluid wave
dyspnea
muffled heart and/or lung sounds
5 major mechanisms of effusions
increased vascular hydrostatis pressure
decreased plasma oncotic pressure
increased vascula permeability
decreased lymphatic drainage
damage to viscera
sample handling and preparation
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
staining
dry slide quickly
prepare several smears
in house Diff-Quik type stain
stain maintenance is important!
Fluid analysis components
gross appearance (color and turbidity)
TP
total nucleated cell count
cytologic examination
abnormal colors
pink to red-blood
yellow-urine
green-bile
white-chylous effusion
turbidity
clear-low cell conc
cloudy-high cellularity or lipid
TP measurement
refractometer
spin first if cloudy
interference with lipema, hemolysis and icterus
TP breakpoints: <2.5, 2.5-3.0, >3.0
Total nucleated cell count
automated
in house-hemacytometer
verify counts by smear evaluation
cytologic evaluation
large mononuclear cells/macrophages
mesothelial cells
lymphocytes
neutrophils
RBCs
eosinophils, mast cells
mesothelial cells
can occur in large rafts or individually
characteristic brush-like eosinophillic border
often appear reactive
transudate
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
transudate cytology
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
causes of transudate
increased hydrostatic pressure-portal hypertension
decreased oncotic pressure-low protein-hepatic insufficiency, PLE, PLN
decrease clearance of fluid-early heart failure, lymphatic obstruction
modified transudate
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
modified transudate causes
increased vascular permeability
lymphatic/vascular obstruction
mild inflammation
cardiac insufficiency, neoplasia, thrombosis, acute organ torsion, diaphragmatic hernia
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?
modified transudate
cardiac insufficiency
Exudate
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
Exudate cytologic eval
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
exudate causes
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
Sandy: 5 yo FS yellow lab
Presented for 2 week hx of lethargy, muffled heart and lung sounds, rads: pleural fluid
Hemorrhagic effusion
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
hemorrhagic effusion: contamination vs hemorrhage
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
hemorrhagic effusion causes
trauma
coagulopathies
neoplasia-eg hemangiosarcoma
Barrett: 5 yo MN greyhound
hx of v, d, anorexia, lethargy, difficulty breathing
PE revealed muffled lung and heart sounds
billious effusion
yellow, green brown/opaque
TP: >3.0 g/dl
TNCC: often >5,000 cells/ul
bilious effusion cyto
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
bilious effusion cuaess
rupture/leakage from biliary tract
trauma
cholelithiasis
cholecysitis/cholangitis
bile duct carcinoma
uroabdomen
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
Uroabdomen cytologic eval
varying number of inflammatory cells-neutrophils, large mononuclear cells
dx: creat conc (Fluid>serum)
distinct patterns of electrolyte change-hyperkalemia, hyponatremia
uroabdomen-causes
trauma
urolithiasis
neoplasia of urinary tract
Chylous Effusion
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
chylous effusion cyto eval
small lymps predominate
% neutrophils and large mononuclear cells increase with chronicity
may see fine lipid vacuoles in background
triglyceride conc: serum vs fluid
chylous effusion causes
idiopathic
cardiac insufficiency
lympathic/thoracic duct obstruction
thoracic duct rupture
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
chylous effusion,
mediastinal mass
neoplastic effusion
light yellow to apricot/clear to cloudy
TP: >2.5 g/dl
TNCC: variable
neoplastic effusion cyto eval
presence of neoplastic cells
+/- inflammation and hemorrhage
must distinguish from reactive mesothelial cells!
neoplastic effusion causes
lymphoma
carcinoma
mesothelioma
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
neoplastic effusion
FIP effusion
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
FIP effusion cyto eval
non-degenerate neutro, large mononuclear cells, small lymphs
often has granular pink (protein) background
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
transudate, chronic
likely due to liver insufficiency or PLN/PLE
idiosyncratic reaction to Mastinib
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
leukocytosis, acute inflammatory/steroid leukogram
marked neutrophilic exudate
culture
hepatocellular carcinoma
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
transudate
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
FIP
leukocytosis with mature and immature neutrophilia, lymphopenia, toxic neutrophils
moderate normocytic, normochromic non-regenerative anemia
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)
