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DWT > Clin path 8: Neutrophilia and Neutropenia > Flashcards

Clin path 8: Neutrophilia and Neutropenia Flashcards

1
Q

What are the main causes of neutrophilia?

A
  1. Stress (cortisol-mediated)
  2. Excitement or physiologic (epinephrine-mediated)
  3. Inflammation
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2
Q

Outcomes of stress neutrophilia

A
  1. storage pools release
  2. Marginal to circulating WBC
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3
Q

When does neutrophilia occur?

A
  • In response to endogenous or exogenous corticosteriods
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4
Q

How long does a stress neutrophilia take to occur?

A

Hours to days

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5
Q

CBC findings that support a stress neutrophilia

A
  • Mild neutrophilia
  • no left shift
  • lymphopenia (Best supporter)
    + or - monocytosis and eosinopenia
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6
Q

Chemistry findings associated with neutrophilia

A
  • Hyperglycemia
  • INcreased ALP (dogs only)
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7
Q

Why does neutrophilia cause hyperglycemia?

A
  • Cortisol has effect on insulin and glycogen production
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8
Q

Why do corticosteroids lead to neutrophilia?

A
  • They increase the rate of nature neutrophils release from bone marrow storage pools
  • They down-regulate adhesion molecules on neutrophils making the marginal neutrophils into circulating neutrophils
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9
Q

Why does stress neutrophilia lead to lymphopenia?

A

Corticosteroids “trap” lymphocytes in the lymphoid organs

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10
Q

What is excitement neutrophilia?

A
  • Occurs in response to epinephrine release
    ** Happens most commonly in young, healthy animals, especially cats and horses
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11
Q

CBC findings associated with excitement neutrophilia?

A
  • Mild neutrophilia
  • no left shift
  • mild lymphocytes
  • Erythrocytosis (splenic contraction)
  • Thrombocytosis (splenic contraction)
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12
Q

Chemistry finding related to an excitement neutrophilia?

A
  • Hyperglycemia
  • Increased ALP (dogs only)
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13
Q

Why is there excitement neutrophilia?

A
  • Epinephrine causes increased HR and BP so marginal neutrophils get “washed” off the walls and into circulation
  • Marginal into circulating pool
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14
Q

How long does the onset of an excitement neutrophilia take?

A

20-30 minutes

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15
Q

What species are we most likely to see the highest excitement neutrophilia in?

A

CATS! they have the largest marginal pool of neutrophils

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16
Q

What is inflammatory neutrophilia?

A
  • Most clinically relevant
  • Bone marrow changes in production of neutrophils
  • Can be from acute or chronic inflammation
    —- Sometimes we can not definitively tell if it is acute or chronic
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17
Q

CBC findings associated with inflammatory neutrophilia?

A
  • Neutrophil count >2x URL
  • Concurrent elft shift
  • Neutrophils in toxic stage
  • Lymphocytosis suggesting chronic inflammation
  • monocytosis
  • hyperfibrinogenemia with a decreased PP:fibrinogen (LA ONLY)
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18
Q

Chemistry findings of inflammatory neutrophilia

A
  • Hyperglobulenemia
  • Hypoalbuminemia
  • Glucose
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19
Q

What does a inflammatory neutrophilia chemistry finding of hyperglobulenemia suggest?

A
  • Chronic inflammation
  • antigenic stimulation
  • lymphoid hyperplasia
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20
Q

What does inflammatory neutrophilia chemistry finding of hypoalbuminemia suggest?

A

Production of albumin by the liver is down-regulated with inflammation **Not a definitive support fo inflammation

21
Q

Why does inflammatory neutrophilia occur?

A

With acute or chronic inflammation:
- Release of neutrophils from bone marrow maturation pool
- The bone marrow will continue to produce more neutrophils
- As the inflammation persists or the severity is greater the bone marrow will push out more and more immature neutrophils
- This can lead to circulation of bands and a significant left shift

22
Q

What is a left shift?

A

an increased number of immature neutrophils in peripheral blood

23
Q

What is a regenerative left shift?

A
  • Moderate to mild
  • Bone marrow is responding to tissue inflammation and releasing earlier neutrophils from maturation pool
24
Q

What is degenerative left shift?

A

There are more immature neutrophils circulating than mature segmented neutrophils
- Bone marrow can not keep up with the peripheral demand for neutrophils
“Overwhelming inflammation” = Poor prognosis

25
Q

What is granulopoiesis?

A

Production of nuetrophils

26
Q

What is toxic change?

A

Increased granulopoiesis in the bone marrow can lead to maturation defects
- Observed in a blood smear

27
Q

What does toxic change occur secondary to?

A
  • shortened maturation time
  • Toxic injury to maturing neutrophils in the bone marrow

Both caused by inflammation

28
Q

What is a leukemoid response?

A

Neutrophil number (any/all types) >50,000/uL
- subtype of chronic imflammation

29
Q

What are causes of leukemoid response?

A

IMHA
The “P’s”
Neoplasia
Hepatozoon infections

30
Q

How does IMHA cause leukemoid response?

A

When severe anemia-induced hypoxemia leads to tissue necrosis/death

31
Q

What are the “P’s”?

A

Pyometra, pyothorax, peritonitis, pylenonephritis, pneumonia

32
Q

How does neoplasia lead to leukemoid response?

A

Having necrotic portions that has outgrown its blood supply

33
Q

What can inflammation with neutrophilia look like?

A
  1. Normal neutrophil numbers + left shift
  2. Normal neutrophil numbers + neutrophil toxic change`
34
Q

What does the magnitude of the neutrophillia reflect?

A

The severity of the inflammation response

35
Q

What does the character/size of the left shift reflect?

A

the severity of the disease and the animals ability to manage it.

36
Q

what is happening in acute inflammation neutrophilia?

A

marginal and storage pools go into circulation and tissues die to demand
- Bone marrow has not had time to respond yet

37
Q

What is happening in chronic inflammation neutrophilia?

A

Neutrophil lineage increases production in response to tissue demands

38
Q

What are the main causes of neutropenia?

A
  1. inflammation
  2. decreased production
  3. sequestration- a transient cause
39
Q

What is neutropenia?

A

a decreased absolute number of neutrophils.

*** Predisposes animal to infection

40
Q

What is inflammation neutropenia?

A

tissue demands for neutrophils exceeds numbers of neutrophils available in the bone marrow

41
Q

CBC findings associated with inflammation neutropenia?

A
  • RBC and platelets unaffected (if decreased this is not ur diagnosis)
    + or - : left shift, toxic change, lymphopenia
42
Q

Chemistry findings associated with inflammation neutropenia?

A

Hypoglycemia due to sepsis

43
Q

Why is there neutropenia? What does it lead to?

A
  • Severe inflammation
  • Tissue demand exceeding marrow supply of neutrophils
  • within 2-3 days animal will succumb to infection
    OR
  • Bone marrow will undergo hyperplasia
  • neutrophil development can be shorted from 5-6 days to 3-4 in all species except ruminants
  • In 3-4 days after hyperplasia neutrophil numbers will increase again but it will be too late
44
Q

What is the different about inflammation neutropenia in ruminants?

A

-Ruminants have a smaller pool of storage neutrophils so it depletes quicker
- this allows for quicker onset of bone marrow hyperplasia
- Ruminates will have bone marrow hyperplasia before they reach the poor prognosis of “overwhelming” inflammation
- therefore better off

45
Q

CBC findings of a ruminant with inflammation neutropenia

A
  • neutropenia
    + or -:
  • mild to marked left shift
  • lymphopenia
46
Q

What is decreased production neutropenia?

A

decreased in neutrophils due to conditions that may inhibit or stop neutrophil development from bone marrow

47
Q

CBC findings associated with decreased production neutropenia?

A

+ or -:
- Decreases in other lineages
- Presence of many immature blast cells that support acute leukemia
- identifiable infectious agents

48
Q

What can cause decreased production neutropenia?

A
  • Viruses
  • Toxins
  • Drugs
  • Estrogen
  • Myelophthisis
49
Q

What is sequestration neutropenia?

A

Decrease in neutrophils die to a transient phenomenon with endotoxemia
- Exotoxin cause a rapid shift of neutrophil from the circulating to marginal
- Tissue inflammation with demand for neutrophils can occur at the same time.

DWT (28 decks)

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