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Small Animal Final Year > Erythroid > Flashcards

Erythroid Flashcards

1
Q

What are the components of blood?

A
  • Fluid (plasma/serum)
  • Ions
  • Proteins
    • (albumin, globulin)
    • [colloid osmotic pressure]
    • hormones
    • mediators
    • clotting factors
    • nutrients
  • Lipids
  • Carbohydrate
  • Gas
  • Cells
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2
Q

What are the functions of blood?

A

Transport

  • nutrients/oxygen
  • removal of waste products
  • hormones and other mediators

Ion buffer – fluid/electrolyte homeostasis

Coagulation

Thermoregulation

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3
Q

What are reticulocytes?

A

Young (immature/non-nucleated) erythrocytes prematurely released to blood from the bone marrow in regenerative anaemias.

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4
Q

How do you visualise reticulocytes?

A

New methylene blue (NMB) precipitation demonstrates

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5
Q

What appearance do reticulocytes have on romanowsky stain?

A

Polychromatophil

Bottom pic

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6
Q

What are the clinical applications of reticulocytes?

A

Evaluation of erythropoiesis in bone marrow

Differentiation of regenerative and non-regenerative anaemia

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7
Q

What is this?

A

Reticulocytes

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8
Q

What can be seen?

A

Clumps of ribosomal RNA & mitochondria

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9
Q

How can we count reticulocytes?

A
  • Manual
  • Automated
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10
Q

How do you calculate absolute reticulocyet count?

A

observed % reticulocytes x RBC (x1012/l) x 10

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11
Q

Reticulocytes in dogs:

A) How many is normal?

B) How many do we expect in regeneratve anaemia?

A

A) Low number of reticulocytes (<1%)

B) Expect at least (>60x109/L) in regenerative anaemias

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12
Q

Cat reticulocyte:

A) How many is normal?

B) What are the 2 morphological types?

C) Which is the only type we consider in regeneration?

D) How many do we expect in regenerative anaemia?

A

A) Low number of reticulocytes (0.2-1.6%)

B)

  • ‘aggregate’ blue stained coarse clumping (0.5% of erythrocytes)
  • ‘punctate’ small, blue stained dots (1-10%).

C) Aggregate in assessment of regeneration

D) Expect at least (>50x109/L) in regenerative anaemia

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13
Q

How many reticulocytes are in normal ruminant and horse blood?

A

Virtually none

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14
Q

When is the peak production of reticulocytes in cattle post blood loss?

A

7-14 days

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15
Q

What animal is this and why?

A

Dog

  • Larger erythrocytes
  • Uniform size
  • Central pallor
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16
Q

What species is this and why?

A

Cat:

Smaller erythrocytes

Anisocytosis (variation in size)

Scarce central pallor (less concave)

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17
Q

What species is this and why?

A

Horse:

Rouleaux

(sedimentation tendency)

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18
Q

What species is this and why?

A

Ruminant

Anisocytosis and crenation

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19
Q

What is the blood variation in:

A) Poodles?

B) Akitas?

C) Greyhounds?

A

A) Macrocytosis

B) Small erythrocytes and high potassium

C) High PCV

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20
Q

How do we measure RBC size?

A

MCV (fL) – mean corpuscular volume

= PCV (L/L) X1000 / RBC count (1012/L)

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21
Q

What is normocytosis?

A

Normal range of RBC size

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22
Q

What can cause macrocytosis? (3)

A
  • Regenerative anaemia
  • FeLV infection
  • Myeloproliferative disease
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23
Q

What can cause microcytosis?

A

Iron deficiency

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24
Q

What is red cell distribution width?

A

A numeric representation of the variability in RBC size

More sensitive than MCV

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25
Q

What is anisocytosis?

A

Unusual large variation in RBC size, eg if large numbers of microcytes or macrocytes (Increased RDW)

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26
Q

Is RDW or MCV more sensitive?

A

RDW

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27
Q

Macrocytsosis:

A) Where is it normal?

B) When is it commonly seen?

A

A) Poodle

B) Damaged or aged samples

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28
Q

Where do you see hypochromic macrocytosis?

A

Regenerative anaemia

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29
Q

What is normochromic macrocytoiss associated with?

A

Feline leukemia virus subgroup A infections in kittens & myeloproliferative disorders in dogs & cats

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30
Q

What is hypochromic microcytosis a marker of?

A

Altered iron metabolism

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31
Q

Name 2 conditions we see microcytosis

A

Iron deficiency – most common cause in dogs: occult blood loss form GI tract; neonatal piglets; blood loss through internal or external parasites

Dogs/cats with portosystemic shunts (liver defect)– effect on iron metabolism currently unknown

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32
Q

Where is it normal to have microcytosis?

A

Akitas

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33
Q

How can we measure the RBC colour?

A

MCH & MCHC

(Mean cell haemoglobin/concentration)

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34
Q

Is MCH or MCHC more useful at measuring RBC colour?

Why?

A

MCHC

Cell size is taken into consideration

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35
Q

How do you calculate MCHC?

A

MCHC (g/L) = Hb(g/L) / PCV(L/L)

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36
Q

How do you calculate MCH?

A

MCH (pg) = Hb(g/L) / RBC(1012/L)

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37
Q

What is it known as to have low Hg content?

A

Hypochromic

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38
Q

What is hypochromic?

A

Low MCHC = low hg content

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39
Q

What is a raised MCHC due to?

A

haemolysis, and may be seen artifactually in lipaemic samples

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40
Q

What is polychromasia?

A

Pinkish/grey colouration of large RBCs on a Giemsa stained blood smear

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41
Q

What is haemoglobin distribution width?

A

Hgb equivalent of RDW (Red cell distribution width)

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42
Q

In dogs what does an average of >10 polychromatic red cells per oil immersion field suggest?

A

Marked regenerative response

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43
Q

What is MCV?

A

Mean cell volume - average red cell size

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44
Q

What is RDW?

A

Red cell distribution width

  • Degree of variation in red cell size
  • Could be more small cells or more large cells or both
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45
Q

What is MCHC and how do you calculate?

A

Mean cell haemoglobin concentration

•Average haemoglobin concentration in cells

MCHC = Hgb/PCV

46
Q

Complete this table

Hypochromic

Normochromic

Hyperchromic

Microcytic

Normocytic

Macrocytic

A

Hypochromic

Normochromic

Hyperchromic

Microcytic

Fe deficiency or PS shunts

?Analytic error – miscounting platelets

Not physiological: indicates lipaemia, sample haemolysis, in-vivo haemolysis or Heinz bodies

Normocytic

If anaemic often inflammation/
chronic illness

Macrocytic

Regenerative anaemia (or cell swelling in sample transport)

Rare (often virus associated) erythroleukaemia

47
Q

What is poikilocytosis?

A

Alteration in cell shape

  • abnormal erythropoeisis
  • specific organ disfunction
48
Q

What are these?

A

Codocytes or ‘Target cells’

49
Q

What is the appearance of Codocytes or ‘Target cells’?

A
  • Appearance of a target with a bullseye;
  • central, hemoglobinized area surrounded by an area of pallor; periphery of the cell contains a band of hemoglobin
  • Lacking normal biconcave cross section due to folding of cell membrane
50
Q

When might Codocytes or ‘Target cells’ be seen?

A

Seen in iron deficiency anaemia, liver disease with cholestasis & after splenectomy of dogs.

51
Q

What is the significance of Codocytes or ‘Target cells’?

A

Very little

52
Q

What are these?

A

Acanthocytes (‘spur cells’)

53
Q

What is the appearance of acanthocytes (spur cells) and why?

A

Rounded projections of variable diameter & length, unevenly distributed

= due to increase in membrane cholesterol or in association with RBC fragmentation

54
Q

Where are acanthocytes seen?

A

Diffuse liver disease, splenic haemangioma, haemangiosarcoma or portosystemic shunts

High cholesterol diet

55
Q

What are these?

A

Spherocytes (and normal RBC)

56
Q

What do spherocytes look like? and why?

A

Small, densely staining spherical RBCs, lack central pallor

Small portions of the cell membrane may have been phagocytosed by mononuclear phacocytes; residual cellular tissue resumes the smallest shape possible – a sphere.

57
Q

Where are spherocytes never seen and why?

A

Rarely recognized in cats since normal RBCs have less of central pallor than in dogs

58
Q

What is the meaning of spherocytes being present?

A

Presence implies that erythrocytes have surface bound antibodies or complement

Indicator of immune-mediated haemolytic anaemia in dogs

Will be present in animals that have received transfusions – cells are damaged and foreign.

59
Q

What are these?

A

Spherocytes - dog

60
Q

What are these?

A

Schistocytes

61
Q

What are the appearance of Schistocytes?

A
  • Irregular, fragmented erythrocytes
  • through mechanical trauma to circulating erythrocytes
62
Q

Where are Schistocytes seen?

A
  • Markers of disseminating intravascular coagulation (DIC) and other angiopathies
  • Seen in immune mediated anaemia, thrombosis, splenic haemangiosarcoma, hypersplenis, glumerulonephritis, congestive heart failure, valvular heart disease, doxorubicin toxicosis and myelofibrosis
63
Q

What are these?

A

Crenation (‘burr cells’)

64
Q

What are Crenation (‘burr cells’)?

A

= RBCs with spiked projections of more uniform length

= “Echinocytes”

65
Q

Where are Crenation (‘burr cells’) seen?

A
  • Some normal in ruminants
  • Rarely snake envenomation
  • Occasionally in dehydration
  • Mostly artefactual!
66
Q

What is this?

A

Schistocytes - eythrocyte fragmentation

67
Q

What is this?

A

Acanthocytes - Few irregular elongations of RBC border with rounded ends

68
Q

What is this?

A

Crenation - Numerous pin-point projections

69
Q

How do you confirm agglutination?

A

Mix 1 drop of blood with 1 drop of saline

= Agglutination will persist, rouleaux formation will disperse

70
Q

What is this?

A

Rouleaux formation - - Clustering/agglutination of RBCs in standing blood

71
Q

Where is rouleaux formation seen?

A

Normal finding in horses.

Indicates inflammation in small animals

Relates to increased “stickiness” of plasma with increased globulin content

72
Q

What can cause agglutination?

A

Immune-mediated haemolytic anaemia

Mismatched blood transfusion

73
Q

What causes Heinz bodies?

A

Oxidative damage

74
Q

What are these signs of?

  • Basophilic stippling
  • Nucleated erythrocytes
  • Howell-Jolly Bodies
A

Signs of regeneration

75
Q

What are these?

Left - methylene blue

Right - Wright stain?

A

Heinz bodies

76
Q

What are heinz bodies?

A

Irregular shaped, refractile inclusions

Consisting of oxidative denatured haemoglobin

77
Q

When are heinz bodies seen?

A
  • Increased numbers in paracetamol and onion toxicity and other oxidative compounds; more common in cats than in dogs
  • Up to 10% of RBCs in normal cats
  • In cats also commonly associated with diabetes mellitus, lymphoma and hyperthyrodism (but also wide range of other diseases
78
Q

What are these?

A

Reticulocyte - RNA-protein complexes

79
Q

What is seen?

A

Heinz bodies - Denatured Haemoglobin

80
Q

What is this?

A

Basophilic stippling

81
Q

What is basophilic stippling and what is it caused by?

A
  • Multiple, small, dark blue, punctate aggregates in RBC
  • In vivo aggregation of ribosome’s into small basophilic granules
  • Caused by low levels of pyrimidine 5’-nucleotidase (P5N), enzyme that catabolizes ribosomes.
82
Q

Where is basophilic stippling seen? (3)

A

In cats (more common) & dogs associated with intensely regenerative anaemia

Associated with lead poisoning (reduced P5N activity)

Normal in immature erythrocytes in ruminants (low levels of P5N are normal)

83
Q

What is this?

A

Nucleated erythrocytes

(nRBC’s, metarubricytes, normoblasts)

84
Q

What is see with Nucleated erythrocytes (nRBC’s, metarubricytes, normoblasts)?

A

Erythrocytes with remains of a nucleus

85
Q

Where are nucleated erythrocytes seen?

A

Regenerative anaemia

  • Early release of RBCs from bone marrow and extra-medullary haematopoiesis sites in response to hypoxia

In absence of anaemia

  • Non functioning spleen
  • Marrow damage
  • In cats, in absence of polychromasia, indication of myelodysplasia or myeloproliferative disease
86
Q

What is this?

A

Howell-Jolly Bodies

87
Q

What is Howell-Jolly Bodies? What does it represent?

A

Refractile, single blueish bodies in RBCs of variable size

Representing nuclear remnants

88
Q

Where are howell jolly bodies seen?

A
  • Regenerative anaemia
  • Splenectomy
  • Suppressed splenic function
  • Higher percentage seen in normal cats
89
Q

What can be seen? Discuss its prescence?

What are the forms?

A

Babesiosis

  • Tick born disease
  • Intracellular
  • Endemic in cattle
  • Dogs: Babesia canis or B. gibsoni, rare in UK, imported

Uncomplicated or complicated forms:

  • Haemolytic anaemia
  • Systemic inflammatory response syndrome (SIRS), Multiple organ disfunciton syndrome (MODS)
90
Q

What is this? What is he appearance? Where is it?

How do we diagnose?

A

Mycoplasma haemofelis

(Haemobartonella felis)

  • Highly pleomorphic, appearing as chains, discs or rods
  • On surface or embedded into RBC membranes
  • Worldwide distribution
  • Diagnosis confirmed by PCR
91
Q

What does mycoplasma haemofleis cause? What are the signs?

A
  • Heamobartonellosis or feline infectious anaemia
  • Variable clinical signs including regenerative anaemia, pyrexia & malaise
92
Q

How do you calculate PCV?

A

PCV = MCV x RBCC

93
Q

Why might PCV be wrong?

A
  • RBC’s miscounted
  • Mistaken for platelets
  • Aggregated into pairs and triplets
  • MCV misleading
  • Cell shrinkage or swelling
  • Transport, tube filling
  • Osmotic effects in machine
94
Q

Why might there be a high MCHC?

A
  • Not physiological to cram more Hgb into red cells than they will take
  • Haemolysis (sample handling or intravascular)
  • Lipaemia
95
Q

Why might MCV be wrong?

A
  • Swelling of transport
  • Mis-identification – pairs and triplets, cross over with large platelets
  • Cell shrinkage or expansion in sample e.g. hyperosmolar
  • Will impact on calculated PCV/HCT
96
Q

How can the rule of three error be picked up?

A

Look at MCHC

Hct (%) approx. = Hgb (g/dL) x3 (+/- 3%).

97
Q

What do you evaluate with the erython?

A

–Is there inadequate, adequate or excessive red cell mass to deliver oxygen to tissues?

–Is there evidence of anaemia?

  • Is there evidence of regeneration?
  • What is the cellular character of the anaemia?

–Normocytic, normochromic, hypochromic, macrocytic

–Is there evidence of polycythaemia

•Relative or absolute?

98
Q

PCV (Hct), RBCC and Hgb:

A) What are they measures of?

B) What are the affcted by?

A

A) Red cell mass and oxygen carrying capacity

B) Haemoconcentration

99
Q

How might we classify anaemia?

A
  • Based on MCV and MCHC
  • Blunt measure - microscope visible findings may not be sufficient to push parameter out of reference range
  • Normocytic normochromic
  • Often anaemia of illness or pre-regenerative or occasionally non-regenerative
  • Macrocytic hypochromic
  • Classic highly regenerative
  • Sometime cell swelling of transport
  • Microcytic hypochromic
  • Classic iron deficiency – chronic external blood loss
  • Without anaemia – portosystemic shunts
100
Q

What is polycythaemia?

A

Increase in PCV, Hb concentration and RBC count

101
Q

What is relative polycythaemia?

A

Apparent increase in RBC due to a decrease in fluid in circulation (often increased­ total protein and albumin)

102
Q

What is absolute polycythaemia?

A

True increase in RBC mass due to increased RBC production/release

103
Q

What does the term Polycythaemia imply?

A

Term polycythaemia implies increased number of several haemopoetic cell lines (human), however dogs & cats with polycythaemia vera usually have normal neutrophil & platelet counts!

104
Q

What is seen with Relative Polycythaemia?

A

PCV is increased but no increase in RBC production

105
Q

When do you get relative polycythaemia?

A

Dehydration” (wáter or acellular fluid loss): = [eg vomiting, diarrhoea, polyuria, extensive Burns, adipsia, wáter deprivation]

Exercise, fear, excitement, severe pain - stress = Adrenaline secretion, splenic contraction and transient redistribution of RBC from the spleen to the circulation

106
Q

How do you resolve Relative Polycythaemia?

A

After rehydration or removal of cause of splenic contraction

107
Q

What is seen with Absolute Polycythaemia?

A

Increased RBC production

108
Q

What is Primary Polycythaemia (polycythaemia vera)?

A
  • Rare myeloproliferative disorder
  • Abnormal response of RBC precursors
  • Normal EPO levels
109
Q

What is Secondary Polycythemia?

What is theEPO value?

A
  • Chronic tissue hypoxia of renal tissues (low arterial pO2) due to:
    • heart/lung diseases, high altitude, thrombosis, constriction of renal vessels
  • Renal tumor or cysts [↑intra-capsular pressure]
  • Increased EPO
110
Q

What test do we do for:

A) Red cell mass?

B) Effective erythropoiesis?

C) Red cell size and variation?

D) Red cell haemoglobinisation?

E) Red cell shape and inclusions?

A

A) PCV/Hct, RBCC, Hgb

B) Size and colour, reticulocyte count

C) MCV, RDW

D) MCHC

E) Smear

Small Animal Final Year (317 decks)

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