Exam 1 lec 3- Flashcards
Hematology Instruments and Blood Cell Measurements
What parameters are included in a CBC for Erythrocytes, Leukocytes, and Platelets?
- Erythrocytes:
- Hematocrit, hemoglobin, RBC count
*Red blood cell number: Hematocrit (HCT), *Packed cell volume (PCV),
*Red blood cell count, hemoglobin (Hgb) concentration
*Red blood cell indices: Mean cell volume (MCV), mean cell hemoglobin (MCH) or optical equivalent (CH), mean cell hemoglobin concentration (MCHC) or optically measured equivalent CHCM), red blood cell distribution width (RDW).
*Nucleated RBC: How nucleated RBC are identified and how they affect the WBC count.
*Reticulocyte counts: Reticulocyte percentage, absolute reticulocyte count that are used to assess regeneration in dogs and cats.
Reticulocyte indices: Results obtained off optical- and flow-based analyzers, which can yield RBC indices for reticulocytes.
- Leukocytes
* Total leukocyte count
* Differential leukocyte count - Platelets count
* Platelet count
* some times Mean Platelet Volume (MPV).
What are some of the benefits of In-house analyzers?
- Rapid information
- Emergencies
- Client services - Analyses of fresh samples
- Rebleed if needed
- Avoids sample deterioration - Information available any time
- Cost effective
The Coulter Impedance Method
- Its inventor Wallace Coulter, is the passage of cells suspended in a known dilution through a small orifice. The electrolyte-containing diluent serves as a conductor of a constant electrical current between two electrodes.
- Change in resistance is proportional to cell volume
- Electrically conductive diluent
Coulter Impedance Instruments
- Count size and number of cells: providing cell volume distributions
- Measure Hemoglobin (Hb) spectrophotometrically
- HCT, RBC, Hb, MCV, MCH, MCHC, RDW are reported
- Can not determine intracellular characteristics of cells
- Total WBC counts (all species) and generally platelet counts (NOT CATS) are generally reported
- Only a 3-part differential based on cell size alone (limited accuracy)
Coulter Impedance Instruments
- Count size and number of cells: providing cell volume distributions
- Measure Hemoglobin (Hb) spectrophotometrically
- HCT, RBC, Hb, MCV, MCH, MCHC, RDW are reported
- Can not determine intracellular characteristics of cells
- Total WBC counts (all species) and generally platelet counts (NOT CATS) are generally reported
- Only a 3-part differential based on cell size alone (limited accuracy)
- Generally less expensive than laser flow instruments
- Can not perform reticulocyte counts
Laser Flow Cytometry
- Forward Scatter: cell size
- Side Scatter: Complexity/Ganularity
Light Scatter
- Cells passing through the laser beam will scatter
- The shadow cast by the cells is referred to as “forward angle light scatter” -forward scatter
- Cells will also scatter light in different directions
- Detectors are placed in front of the laser beam to measure forward scatter, and at angles (typically 90 degrees) to the laser beam to detect light scattered to the side
Forward Scatter, what does the detector measure?
- It measures cell’s “shadow” which is a relative indicator of the cell’s size.
- Large cell (e.g., neutrophil) casts a large shadow.
- Lymphocytes = small shadow
Laser Flow Cytometry
- What does it determine?
- Counts and classifies cells based on what?
- How many part differential counts does it provide?
Dot Plot Displays: IDEXX Procyte Dx
- Forward Scatter: cell size
- Side Scatter: Complexity/Ganularity
1. Size and complexity
2. Based on extinction of light and scattered light
3. Total WBC and 5-part differential counts (basophils not accurate in dogs). - Platelet counts, MPV, PDW (Platelet cell distribution width), PCT.
- HCT, RBC, Hb, MCV, MCH, MCHC, RDW.
- Reticulocyte counts
- Large instruments such as Advia 2120 offer many more measurements
Light Scatter
- Cells passing through the laser beam will scatter
- The shadow cast by the cells is referred to as “forward angle light scatter” -forward scatter
- Cells will also scatter light in different directions
- Detectors are placed in front of the laser beam to measure forward scatter, and at angles (typically 90 degrees) to the laser beam to detect light scattered to the side
Side (90 degrees = “Right angle”) Scatter
What does the detector measure?
What are fluorescent labels used for?
- It is a measure of the cell’s internal complexity or granularity.
- Neutrophils, with multilobed nucleus and granules have high amounts of side scatter.
- Lymphocytes with their high nucleus: cytoplasm ratio and scant cytoplasm have lower levels of side scatter
Fluorescent labels
-may be used to ID cell types
Side (90 degrees = “Right angle”) Scatter
What does the detector measure?
What are fluorescent labels used for?
- It is a measure of the cell’s internal complexity or granularity.
- Neutrophils, with multilobed nucleus and granules have high amounts of side scatter.
- Lymphocytes with their high nucleus: cytoplasm ratio and scant cytoplasm have lower levels of side scatter
Fluorescent labels
-may be used to ID cell types
What is RBC count used for?
- Little value by itself
- To calculate Hct electronically
- Used to calculate MCV and MCH manually
PVC and Hct Determinations
- What is one of the requirements?
- What is the formula for Hct?
- Centrifugation for PCV
- Hct (%) = MCVRBC/10
- Example: 686.6/10 = 45%
Hemoglobin Determinations
What reagent is used and what does it do?
What can cause falsely increased values (and in non-mammals)?
- Spectrophotometric assay: blood is diluted and RBC lysed to measure Protein concentration and Absorbance.
- Sodium lauryl sulfate (SLS) reagent
- Lyses erythrocytes
- Oxidizes Hb to MetHb and forms a stable SLS-MetHb product.
- Lipemia
- Heinz bodies
- Nuclei in non-mammals
Erythrocytes indices Erythrocytes Histograms (Relative number vs. Cell Volume fl).
- Mean cell Volume (femtoliters). Average volume of a single erythrocyte (fL = 10^-15 liter). Determined directly in hematology analyzers.
- Mean cell Hemoglobin (not very useful): Average amount of Hb in a single erythrocyte (picogram = 10^-12 gram). Generally correlates directly with changes in erythrocyte size (MCV). Depends to a lesser extent on internal Hb concentration. Lowest values are reported in severe iron deficiency anemia (low MCV and low internal Hb concentration).
-Mean cell Hemoglobin Concentration: determined by calculation g/dL of packed erythrocytes (NOT g/dL whole blood).
HCT = 45%
Hb = 15 g/dL
Formula: (Hb/HCT) * 100.
Example: (15/45)*100 = 33 g/dL (packed RBC).
-Red Cell Distribution Width
What are the MCV (fL) in Domestic mammals?
- Horses: 38-51
- Cattle: 38-50
- Dogs: 64-74
- Cats: 42-52
- Goats: 16-25
Red Cell Distribution Width
What is the formula?
Spuriously Increased RDW
- SD of Erythrocyte Volumes/ MCV *100
- Coefficient of variation of erythrocyte volumes and an electronic measure of anisocytosis (Anisocytosis is the medical term for having red blood cells (RBCs) that are unequal in size).
Spuriously Increased RDW
- Erythrocyte agglutination
- Platelets counted in erythrocyte histogram of severely anemic patients
What are Reticulocytes?
How is absolute Reticulocyte Counts determined?
How are they verified?
Reticulocytes are immature, anucleate erythrocytes which are released from bone marrow into the blood in increased numbers as a response to anemia caused by hemolysis (destruction) or loss (hemorrhage) of erythrocytes in most species (horses are a notable exception)
-Absolute reticulocytes counts are determined by flow cytometry and validated using manual counts
- Verify which reticulocytes are counted in cats. Only aggregate reticulocytes are counted in most instruments.
- *Aggregate Reticulocytes
- *Punctuate Reticulocytes
Spurious Reticulocytosis
- Erythrocyte parasites containing RNA and DNA, e.g., hemotropic mycoplasmas, Babesia species.
- Howell-Jolly bodies (micronuclei)
- Nucleated erythrocytes
- Large immature platelets or platelet clumps
- Heinz bodies with nonspecific fluorescence
- Autofluorescence (drugs, porphyrin)
- Leukocytosis- uncommon
False Platelet Counts
What is Mean Platelet Volume the average of?
- Platelet aggregates can result in false thrombocytopenia. Platelet activation during blood collection and handling (especially in cats)
- Verify PLC by stained blood film examination
- Automated PLC are often unreliable in cats
MPV: is the volume average of a single Platelet
MPV in Domestic Mammals
- Horse: 5.9-9.9
- Cattle: 4.5-7.5
- Dogs: 6.7-11.1
- Cats: 11.0-18.1
Spuriously Increased MVP
- Platelet aggregates
- Storage of blood at 5 C
What are some errors in Blood Cell Measurement?
What is the formula for Corrected White Blood Cell Count?
- Nucleated erythrocytes (Nucleated Red Blood Cells)counted as leukocytes by manual and most automated cell counters
- *Calculate corrected total leukocyte count before calculating absolute differential leukocyte counts**
Machine WBC *(100/100+NRBC) = Corrected WBC
Example: 15x10^3 per uL *(100/100+50) = 10x10^3 per uL
Sample errors: Platelet, leukocyte, erythrocyte aggregates
Clot Formation and Cryoglobulins have what effect on cells?
- Number of cell per uL blood decreases
- Erythrocyte aggregates increase MCV, decrease electronic HCT, increase MCHC.
- Platelet aggregates may be counted as leukocytes
- MPV is increased with platelet aggregates
- Collection in citrate may reduce platelets and leukocytes aggregates
Clot formations: decrease all cell types
Cryoglobulins (precipitate below body temperature): may be counted as leukocytes or platelets
What does hemolysis, lipemia, heinz bodies do to test results?
Hemolysis: MCHC (mean cell hemoglobin concentration) increased
- In vivo = intravascular hemolysis
- In vitro = sample handling, Lipemia
- Cross-linked hemoglobin (Oxyglobin) treatment
Lipemia:
- Hb and MCHC increased
- May increase leukocyte or platelet counts
Heinz bodies
- Hb and MCHC increased
- Sometimes total leukocyte counts are increased
- Reticulocyte counts may be increased
Lecture 4
Plasma Proteins and Dysproteinemia
What is plasma comprised of?
Where are plasma proteins synthesized? Plasma proteins vs. Immunoglobulins
What is the major components of Blood?
Compare Plasma’s composition vs. Serum’s composetion
- Comprised of hundreds of proteins, many protein structures and functions
- Liver: synthesizes most plasma proteins
- Lymphoid organs: immunoglobulins
Blood
- Blood cells
- Plasma
a. Water
b. Proteins
Proteins
a. Albumin
b. Globulin
c. Fibrinogen
Blood
- Platelets VII, V, II, I = coagulation factors.
- XIII, XI, IX, VII, VIII, V, X, II, XII, I.
Serum
-XIII, XI, IX, VII, VIII, V, X, II, XII, I. I = Fibrinogen.
What are some of the functions of Plasma Proteins?
How does neonate PP compare to adults?
- Immune defense
- Hemostatic
- Acid-base
- Transport of nutrients, hormones, waste, drugs.
- Inflammation
-Neonate lacks immunoglobulin until colostrum intake and absorption. They continue to increase with age.
What are some methods of protein measurement in plasma?
What conditions lead to erroneous readings in each method?
Which protein migrates the farthest in Serum Protein Electrophoresis?
When is SPE performed?
- Physical
- Refractometry: measures total solids in plasma or urine. Routinely performed in vetmed. Quick screed of total plasma proteins. Based on the fluid’s refractive index.
* *Hemolysis = Increased PPC due to Hb (plasma protein concentration)
* *Lipemia: interference with light transmission
* *Increased nonprotein solids: glucose, urea nitrogen in kidney - Biochemical: adding a reagent
- Spectrophotometric: Detector measures light absorbance of protein concentration
- Assays: a. Total globulin = subtracting albumin concentration from total protein concentration. b. Total protein concentration minus albumin concentration = total globulins concentration.
- Fraction of Serum/Plasma Proteins: various alpha, Beta, Gamma, globulin bands. Stain proteins for protein, carbohydrate, and lipids. - Fractionation
- Electrophoresis: negative charged proteins travel/migrate to positive charge (Anode +), (Cathode -).
* *Albumin migrates the farthest.
SEP (serum protein electrophoresis) is performed when
- Unexplained hyperglobulinemia is present
- Immunoglobulin deficiency is expected.
- SPE abnormalities are seldom specific for a given disease.
Albumin
How much does it weigh? What does it contain? What is the osmotic pressure relation? What functions does it have? How is low Ca++ in blood related to Albumin?
- Single homogenous protein
- 66kDa
- Contains minimal carbohydrate
- *Osmotic pressure: Hypoalbuminemia can result in edema**
- Transport functions: organic and inorganic substances. Cations (Ca++), metabolites, hormones, poorly soluble drugs, toxic substances.
- *Hypoalbuminemia = low Ca++ in blood.**
What is Acute Phase Proteins?
What inflammatory cytokines are involved?
How are they categorized?
What does increased production of positive APP indicate?
APP especially helpful in what species?
- Proteins with >25% change in serum concentrations in response to inflammatory cytokines (IL-1, TNF-alpha, IL-6).
- Categorized as positive (increase in serum) and vice-versa.
- Increased APP = indicator of inflammation, which can develop prior to leukogram.
- Species where it is helpful: cattle and manatees bc often do not exhibit prominent leukogram changes in response to inflammation.