General pathophysiology - hematology, inflammation Flashcards
define prodromal period
the time during which patient experiences vague
symptomes such as fatique or loss of appetite before the
onset of specific signs and symptoms.
3 terms for death in latin
mors, mortis
exitus letalis
define normality
What is termed a normal value for a laboratory test is established statistically from test results obtained from a selected sample of people/animals.
The normal values refer to the 95% distribution (mean plus or minus two standard deviations [mean ± 2 SD]) of test results for the reference population.
Reliability refers to
the extent to which an observation, if repeated, gives the same result.
Validity refers to
the extent to which a measurement tool measures what it is intended to measure.
This often is assessed by comparing a measurement method with the best possible method of measure that is available.
Although predictive values rely in part on sensitivity and specificity, they depend more heavily on
the prevalence of the condition in the population.
Despite unchanging sensitivity and specificity, the positive predictive value of an observation rises with prevalence, whereas the negative predictive value falls.
define self-limiting
(a.k.a. self-recovering) is a term used in clinical medicine to refer to any disease whose natural history is to resolve without treatment
define recidiviation
to relapse into a previous condition or mode of behavior: to exhibit recidivism
These symptoms are then called recidive.
alt. term for relapse
recidiviation, recidive
define metaphylaxis
Group treatment of all clinically healthy (but presumably infected) animals kept in close contact with animals showing clinical signs of a contagious disease.
Metaphylaxis is always combined with the treatment of the diseased individuals.
define kinetosis
the state of being dizzy or nauseated because of the motions that occur while traveling in or on a moving vehicle. synonyms: motion sickness.
describe I degree burns
erythema and dry, but without blisters (such as mild sunburn)
affects the epidermis
describe II degree burns
red, swollen, and blistered skin
(erythema bullosa), subepidermal
describe III degree burns
throughout the epidermis with skin necrosis
affects the dermis and can reach the subcut. tissue
white and charred-looking
describe IV degree burns
charred skin with possible exposed bone
define insolation
exposure to the sun’s rays.
the amount of solar radiation reaching a given area.
name 3 types of radiation capable of causing injury
- Ionizing Radiation
- Ultraviolet Radiation
- Nonionizing Radiation
describe Ionizing Radiation injury
Causes ionization of molecules and atoms in the cell, by directly hitting the target molecules in the cell, or by producing free radicals that interact with critical cell components.
describe Ultraviolet Radiation
The degree of risk depends on:
the type of UV rays,
the intensity of exposure, and
the amount of protective melanin pigment in the skin.
describe Nonionizing Radiation injury
Unlike ionizing radiation, which can directly break chemical bonds,
nonionizing radiation exerts its effects by causing vibration and rotation of atoms and molecules.
Phytophotodermatitis caused by
contact with the photosensitizing compounds found naturally in some
plants and vegetables like parsnips, citrus fruits, and more.
is a form of plant dermatitis
alt. terms for Sunburn and Photodermatitis
sun poisoning
photoallergy
Teratogens are
environmental agents that can harm the developing fetus
Teratology is the study of
abnormalities of physiological development. (embryotoxic or foetotoxic effects)
define genotoxins
Agents that damage to DNA causing lesions that result in cell death or mutations
The effect of electricity on the body is mainly determined by? (4)
- its voltage,
- the type of current; (i.e., direct or alternating),
- its amperage, the resistance ot the intervening tissue, the pathway of the current,
- the duration of exposure
define Oxyhemoglobin
a compound of hemoglobin with oxygen that is the chief means of transportation of oxygen from the air (as in the lungs) by way of the blood to the tissues.
define COHb
Carboxyhaemoglobin is a very stable combination of hemoglobin and carbon monoxide formed in the blood when carbon monoxide is inhaled with resulting loss of ability of the blood to combine with oxygen.
define MetHb
Oxidation of ferrous (+2) to ferric (+3) iron in hemoglobin converts oxygen carrying oxyhemoglobin to methemoglobin which does not carry oxygen.
Methemoglobin does not bind oxygen, thus effectively leading to a functional anemia. In addition, methemoglobin causes a leftward shift of the oxygen-hemoglobin dissociation curve, resulting in decreased release of oxygen to the tissues.
Most cases of methemoglobinemia are acquired and result from exposure to certain drugs or toxins.
Altitude sickness is a
pathological effect of high altitude caused by acute exposure to low
partial pressure of oxygen at high altitude. It commonly occurs above 2,400 metres (humans).
Decompression sickness is
(DCS; also known as divers’ disease, the bends, or caisson disease)
a condition arising from dissolved gases (mainly nitrogen) coming out of solution into bubbles inside the body on depressurisation that causes gas embolism.
Nitrogen narcosis is
a reversible alteration in consciousness that occurs while diving at depth.
(also known as nitrogen narcosis, inert gas narcosis, raptures of the
deep, Martini effect)
It is caused by the anesthetic effect of
certain gases at high pressure.
define autointoxication
poisoning by a toxin formed within the body itself.
products of altered metabolism or toxines from tissue breakdown (disease process involved)
define metaplasia
Metaplasia refers to the replacement of a mature, differentiated cell type by another mature, differentiated cell type that does not typically occur in the tissue in which it is found. It’s usually a response to chronic
inflammation or irritation.
e.g. conversion of fibrous tissue into bone
name 3 types of hyperplasia
Physiologic hyperplasia — for example, monthly increase in the number of uterine cells in response to estrogen stimulation after ovulation.
Compensatory hyperplasia — for example, regeneration of liver cells when part of the liver is surgically removed.
Pathologic hyperplasia — for example, acromegaly, in which excessive growth hormone production causes bones to enlarge.
Three structures in the brain are primarily responsible for maintaining homeostasis of the entire body:
medulla oblongata
pituitary gland
reticular formation
dysarthria
difficulty speaking
bronchorrhea
defined as production of voluminous watery sputum greater than 100 mL/d
epiphora
excessive tear production
polycythemia
also called erythrocytosis, refers to increased red blood cell mass
can be relative or absolute
relative typically being caused by dehydration and absolute known as polycythemia vera a true excess.
can be caused by a myeloproliferative neoplastic disorder involving uncontrolled red blood cell production
Steatorrhea
is the presence of excess fat in feces.
insulinoma
is a tumour of the pancreas that is derived from beta cells and secretes insulin. It is a rare form of a neuroendocrine tumour.
gastrinoma
neuroendocrine tumor (NET), usually located in the duodenum or pancreas, that secrete gastrin and cause a clinical syndrome
pollakiuria
frequent, abnormal urination during the day.
what is Price-Jones curve
a graph showing the distribution of diameters of red blood cells.
Higher diameter may be seen in pernicious anaemia, while lower diameter may be seen after haemorrhage.
pernicious = highly injurious or destructive
nosology
the branch of medical science dealing with the classification of diseases.
define Oligochromemia &
Oligocythemia
deficiency of Hb in the blood
deficiency in the total number of RBCs present in the body
The three basic causes of anemia:
(1) decreased RBC production by the bone marrow,
(2) loss from the body (i.e., external hemorrhage), and
(3) destruction in the body (i.e., hemolysis).
where is EPO produced in response to what
Erythropoietin – a peptide/glycoprotein hormone produced by the kidney in adult animals (in the liver in neonates) that enhances erythropoiesis by stimulating formation of proerythroblasts.
Hypoxia stimulates EPO release.
pernicious anemia
is a type of vitamin B12 deficiency anemia, a disease in which not enough red blood cells are produced due to the malabsorption of vitamin B12.
Malabsorption in pernicious anemia results from the lack or loss of intrinsic factor needed for the absorption of vitamin B12 which is required for maturation of erythrocytes.
2 signs of regenerative anemia
Reticulocytosis and polychromasia
Polychromasia is the presentation of multicolored red blood cells in a blood smear test. It’s an indication of red blood cells being released prematurely from bone marrow during formation.
MCH
mean corpuscular hemoglobin – the average mass of Hb per red blood cell in a sample of blood
MCHC
mean corpuscular hemoglobin concentration – the average concentration of Hb in the red blood cells
MCV
mean cell/corpuscular volume – the average volume of a red blood cell in femtoliters
Howell-Jolly bodies
is a cytopathological finding of basophilic nuclear remnants (clusters of DNA) in circulating erythrocytes.
occur where there is no spleen or an non-functioning spleen, referred to as asplenia.
Cabot’s rings
RBCs with the remnants of the nuclear membrane
are thin, red-violet staining, threadlike strands in the shape of a loop or figure-8 that are found on rare occasions in red blood cells
name 3 signs of inhibition of erythropoiesis
Degenerative forms of RBCs (right shift)
poikilocytes, anisocytes, hypochromic RBCs
define spherocytes
are red blood cells that are sphere-shaped rather than the usual flattened but round doughnut shape. Normal RBCs should jave central pallor, spherocytes do not.
Spherocytes are more fragile than normal red cells and their presence is accompanied by anemias of varying severity.
Siderocyte
is defined as red blood cell containing nonhemoglobin iron
Sideroblastic anemias are iron-utilization anemias, which are characterized by inadequate marrow utilization of iron for heme synthesis despite the presence of adequate or increased amounts of iron.
Thalassemia
is an inherited blood disorder caused when the body doesn’t make enough of a protein called hemoglobin
Ferritin and Hemosiderin
Hemosiderin and ferritin are iron-containing proteins with magnetic susceptibility. Hemosiderin is water-insoluble and thermally denatured, but ferritin is water-soluble and heat-resistant up to 75°C.
Serum ferritin is the most commonly used marker of stored body iron.
TIBC, UIBC
TIBC = total iron-binding capacity
UIBC = Unsaturated iron-binding capacity
The sum of the serum iron and UBIC represents the total iron-binding capacity.
(TIBC, total iron binding capacity is the laboratory term
for transferrin)
transferrin is the main iron transport protein
(It is an essential biochemical marker of body iron status.)
ferritin is an indicator of cellular iron stores
Coomb’s reaction
The direct Coombs test is used to detect antibodies or complement proteins attached to the surface of red blood cells.
The direct Coombs test is used to test for autoimmune hemolytic anemia.
Pyknocytes
are red blood cells that appear distorted, irregular and small with abnormal projections
Eccentrocytes
are RBCs that appear in a peripheral blood smear to have their hemoglobin shifted to one side of the cell. This abnormality, which is confined to the RBC membrane and cytoskeleton, is induced by oxidative damage.
(Sphero)echinocytosis
echinocyte refers to a form of red blood cell that has an abnormal cell membrane characterized by many small, evenly spaced thorny projections.
spherocyte refers to cells that are round like a sphere, are more fragile than disk-shaped RBCs.
so sphero-echinocyte is a round RBCs with lots of thorny projections.
describe Heinz Body Anemia morphology
may appear as lighter or darker depending on stain, single round bodies within RBCs or may bulge from the cell surface. due to denatured hemoglobin.
- finding any Heinz bodies in canine blood is diagnostic.
- healthy and ill cats frequently have Heinz bodies.
Pyruvate Kinase Deficiency
is an inherited metabolic disorder of the enzyme pyruvate kinase in which red blood cells break down faster than they should.
basenji, West Highland white terrier, or beagle dogs
Phosphofructokinase deficiency
is a rare muscular metabolic disorder, with an autosomal recessive inheritance pattern.
In this condition, a deficiency of the M subunit of the phosphofructokinase enzyme impairs the ability of cells such as erythrocytes and rhabdomyocytes (skeletal muscle cells) to use carbohydrates (such as glucose) for energy.
occurs in English springer spaniels
rubricyte
an immature red blood cell that has a nucleus, is about half the size of developing red blood cells in preceding stages
Aplastic pancytopenia
is a disease in which the bone marrow, and the blood stem cells that reside there, are damaged. This causes a deficiency of all three blood cell types (pancytopenia)
(also aplastic anemia or fatty bone marrow)
- if hemic tissue is replaced by fatty tissue
Myelofibrosis
replacement of hemic tissue by fibrous connective tissue, collagen, or reticulin fibers
fibrosis = connective tissue proliferation (by fibroblasts)
Cold Hemagglutinin Disease
is a condition that makes your body’s immune system attack your red blood cells and destroy them. It’s triggered by cold temperatures, and it can cause problems that range from dizziness to heart failure. It’s also called cold antibody hemolytic anemia
Macrophage Proliferative Disorders
Macrophage and histiocyte proliferative disorders may be malignant or benign.
Malignant disorders include malignant histiocytosis and disseminated histiocytic
sarcoma.
Histiocytic disorders (i.e., systemic histiocytosis, malignant histiocytosis) are closely associated with Bernese mountain dogs.
Malignant histiocytosis has aggressive proliferation of very atypical cells in a variety of
tissues and has pancytopenia. Benign conditions have been termed hemophagocytic syndromes or hemophagic histiocytosis.
define normoblast
the erythrocyte precursor that comes before reticulocyte
during the normoblast phase the nucleus shrinks and is eventually reabsorbed
an immature red blood cell containing hemoglobin and a pyknotic (necrotic) nucleus and normally present in bone marrow but appearing in the blood in many anemias
what 3 playerss regulate Ca and PO4 uptake or release.
Parathyroidhormone, calcitonin and vitamin D
pleocytosis
is an increased cell count (from Greek pleion, “more”), particularly an increase in white blood cell count, in a bodily fluid, such as cerebrospinal fluid. It is often defined specifically as an increased white blood cell count in cerebrospinal fluid.
what does toxic change in neutrophils. look like
are morphologic abnormalities acquired during maturation under conditions that intensely stimulate neutrophil production and shorten the maturation time in marrow
Toxic granulation is the presence of large purple or dark blue cytoplasmic granules (primary granules) in neutrophils, bands, and metamyelocytes. The granules are slightly larger, more numerous and have an increased staining density compared to normal neutrophil granules.
What is osteochondritis dissecans?
Osteochondritis dissecans is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.
hemosiderin
is an iron-storage complex that is composed of partially digested ferritin and lysosomes. The breakdown of heme gives rise to biliverdin and iron. The body then traps the released iron and stores it as hemosiderin in tissues. Hemosiderin is also generated from the abnormal metabolic pathway of ferritin.
xanthochromic
Xanthochromia, from the Greek xanthos (ξανθός) “yellow” and chroma (χρώμα) “colour”, is the yellowish appearance of cerebrospinal fluid that occurs several hours after bleeding into the subarachnoid space caused by certain medical conditions, most commonly subarachnoid hemorrhage.
What is pre vs post renal azotemia?
- Prerenal azotemia is a consequence of reduced renal perfusion (e.g., severe dehydration, heart failure).
- Postrenal azotemia results from interference with excretion of urine from the body (e.g., obstruction, uroabdomen).
acanthocytes
Acanthocytes are also called spur cells. They are dense, shrunken, and irregularly shaped red blood cells with spikes on the outside.
Ferritin
Ferritin is a complex of a protein (apoferritin), and iron (ferric
hydroxide). Ferritin is a readily available source of iron.
Serum ferritin is in minute quantities but is proportional to the amount of iron stored as
ferritin and hemosiderin. Serum ferritin may be used to estimate total body iron stores
without more invasive techniques.
hemochromatosis
Idiopathic
abnormally high iron absorption and iron overload is termed hemochromatosis.
histiocytosis
Histiocytosis is a general name for a group of disorders or “syndromes” that involve an abnormal increase in the number of specialized white blood cells that are called histiocytes.
A histiocyte is a normal immune cell that is found in many parts of the body especially in the bone marrow, the blood stream, the skin, the liver, the lungs, the lymph glands and the spleen. In histiocytosis, the histiocytes move into tissues where they are not normally found and cause damage to those tissues.
physiologic leukocytosis
refers to an increase in the number of circulating leucocytes which occurs either in response to physical exercise or to increased levels of adrenalin in otherwise healthy human beings. The mechanism underlying this phenomenon and its physiological implications are not known.
Relative leukocytosis
an increased proportion of one or more types of leukocytes in the
circulating blood, without an actual increase in the total number of
WBCs.
Absolute leukocytosis
an actual increase in the total number of leukocytes in the circulating
blood, without any change in the proportion of different types of
WBCs.
A leukemoid reaction is a
marked leukocytosis (> 50,000 to 100,000 WBCs/ul) as the result of
inflammation.
pollinosis
hay fever
difference between exudate and transudate
“Transudate” is fluid buildup caused by systemic conditions that alter the pressure in blood vessels, causing fluid to leave the vascular system. (ascites, edema)
“Exudate” is fluid buildup caused by tissue leakage due to inflammation or local cellular damage. (pus)
name 3 connective tissue cells that participate in the inflammatory response
mast cells, macrophages, fibroblasts
name 3 vasoactive amines
– histamine,
– serotonin
– bradykinin
name 3 Eicosanoids (derivatives of arachidonic acid)
– prostaglandins
– thromboxanes
– leukotrienes
how do you distinguish inflammatory edema from non-inflammatory edema
heat, redness in inflammatory
pitching/blanching resolves much faster in inflammatory than non-
Cirrhosis
is scarring (fibrosis) of the liver caused by long-term liver damage. The scar tissue prevents the liver working properly.
Resolution
recovery of damaged tissue (cell death has not occurred)
Regeneration
replacement of the damaged tissue with the same tissue, complete recovery of the function
Reparation (healing)
repair of damaged tissue by connective tissue proliferation, which later becomes scar
tissue
the 5 signs of inflammation in latin
calor (heat)
dolor (pain)
functio laesa (malfunction)
rubor (redness)
tumor (swelling)
Catarrhal exudate
Catarrh is an exudate of inflamed mucous membranes in one of the airways or cavities of the body, usually with reference to the throat and paranasal sinuses.
It can result in a thick exudate of mucus and white blood cells caused by the swelling of the mucous membranes in the head in response to an infection.
Fibrinous exudate
Beside plasma albumins and globulins, exudate
contains abundant fibrinogen. Fibrinogen is converted into
fibrin that builds up in the mucous membranes; when
removed, leaves no defects.
Putrescent/ Non-purulent- Exudate
exudate and inflammatory lesions contain microbes that degrade proteins and cause a pungent or rotten odour.
Empyema
Empyema is the medical term for pockets of pus that have collected inside a body cavity
Phlegmon
is a medical term describing an inflammation of soft tissue that spreads under the skin or inside the body. It’s usually caused by an infection and produces pus.
The pathogenesis of fever begins with the production of
endogenous pyrogen (EP) by macrophages/phagocytic leukocytes in response to exogenous pyrogens (toxic, immunologic or infectious agents).
How does the digestive system respond to fever?
Intensification of putrefaction, accumulation of gas (meteorism).
Decreased motor and secretory activity is due to increased sympathetic tone.
In ruminants, decrease in the secretion of alkaline saliva can be observed causing excess acid build-up in the rumen. may destroy ruminal bacteria and protozoa that may lead to ruminal atony.
Mostly water and carbohydrates are absorbed by the intestine during fever – starvation. This should be considered when compounding rations – carbohydrate-rich diet + frequent provision of water.
how does the CIRCULATORY/CARDIOVASCULAR SYSTEM respond to fever?
Heart rate is known to increase by 8 to 10 bpm per degree centigrade increase in body temperature.
Increase in blood pressure due to tachycardia and blood vessel contraction will occur.
Rapid fall/drop in body temperature in case of septic fever (crisis) may lead to circulatory/cardiovascular collapse – heart failure and collapsed arteries and/or veins (manifests clinically as a shock).
how does the RESPIRATORY SYSTEM respond to fever?
Compensatory rapid breathing/increase in respiration to facilitate heat loss via respiratory system and improve oxygen supply.
Febris ephemera
Fever that persists for a few hours
Febris continua
Continuous fever that lasts for weeks.
Temperature changes are less than 1’C in 24 hours
Febris remittens
Long-lasting fever with temperature swings
(over 1 in 24 hours)
Febris hectica
Prolonged fever with considerable daily fluctuations (4-5 ‘C)
Febris recurrens
Alternation of fever and apyretic periods of certain duration
describe the stages of fever
5 stages:
Phase of increase (stadium incrementi) – Increase in heat production due to shivering, increased heart and respiration rate, and peripheral vasoconstriction. Animals refuse to eat, but drink more.
Climax phase (stadium acme) – The body temperature culminates. Both heat production
and heat dissipation exceed normal levels. Increased heart rate and respiration. Animals refuse to eat, are thirsty and exhausted/fatigued.
Descent stage (stadium decrementi) – Fever decreases to normal temperature. Sweat
secretion and vasodilation.
Crisis - rapid drop in fever
Lysis - fever drops gradually in the course of several days
Normocytic normochromic RBCs can indicate..?
Normocytic normochromic when
MCV 80-100 fL, MCHC is in normal range
- Disturbance in erythropoiesis – bone marrow malfunction
Most normocytic anemias appear to be the outcome of the impaired production of RBCs.
Microcytic hypochromic RBCs can indicate
Microcytic hypochromic when MCV <80 Fl, MCHC is lower than normal
- Disturbance in haemoglobin synthesis – iron deficiency anemia
Macrocytic hyperchromic RBCs can indicate
Macrocytic hyperchromic when
MCV >100 Fl, MCHC is higher than normal
- Defects in nuclear maturation – Vitamin B12 and folic acid deficiency anemias
Macrocytic hypochromic RBCs can indicate
Macrocytic hypochromic when
MCV >100 fL, MCHC is lower than normal
- Disturbances of DNA synthesis - Both folic acid and vitamin B12 deficiency anemia
Microcytic normochromic RBCs can indicate
Microcytic normochromic when
MCV <80 fL, MHCH is in normal range
- iron deficiency/depletion, especially if schistocytosis is present.
A schistocyte is a fragmented part of a red blood cell.
unique venipuncture site for swine
cranial vena cava accessed from the right thoracic aperture of a standing pig or placed in dorsal recumbency
What does corrected reticulocyte count mean?
How do you calculate it?
Because the reticulocyte count is expressed as a percentage of total RBCs, it must be corrected according to the extent of anemia.
In anemia, the patient’s red blood cells are depleted, creating an erroneously elevated reticulocyte count.
corrected percentage (CRP) = retic % x hematocrit / normal hematocrit
After calculating the corrected reticulocyte count, you would generally continue on to calculate the reticulocyte index by utilizing a table with expected retic. life expectancy. So, CRP / expected retic half life = retic. index.
PRCA
Pure red cell aplasia is a blood disorder that happens when your bone marrow doesn’t produce the normal number of red blood cells
can be a consequence of chronic anemia
Polychromatophilia
It means there is more staining than normal
when reticulocytes show up as bluish-gray when they are stained with a particular type of dye. This happens when they are immature because they were released too early from your bone marrow.
what is pernicious anemia
pernicious = highly injurious or destructive
Pernicious anemia is a decrease in red blood cells that occurs when the intestines cannot properly absorb vitamin B12.
is synonymous with vitamin B12 or folate deficiency anaemia
Many species either have an inconsistent reticulocyte response or have no reticulocyte response in the peripheral blood.
give species examples
inconsistent reticulocyte response (e.g., cattle)
no reticulocyte response (e.g., horses)
What is a reticulocyte index?
And how is it calculated?
Prematurely released “shift” reticulocytes live longer than the usual 1 day, as is shown in the table. This exaggerates the reticulocyte precentage, so the corrected reticulocyte percentage/CRP is further adjusted by dividing it by the expected maturation time in days, which varies with the severity of anemia. The resultant index-number is the reticulocyte index.
An RI greater than 1 in dogs indicates regenerative anemia. An RI of 3 or greater indicates marked regenerative response.
RI = CorrectedReticPercentage / Maturation correction (chosen from the table)
What canine PCV % would be classed as a mild anemia?
Mild anemias in the dog have a PCV in dog 30 – 36% range
What canine PCV % would be classed as a moderate anemia?
Moderate canine anemias have a PCV of 20 – 29%
What canine PCV % would be classed as a severe anemia?
A severe canine anemia has a PCV of 13 – 19%
How would you calculate absolute reticuolyte count?
RBC number x reticulocyte percentage
e.g. RBC 2 x 106/µ l , Reticulocytes 25%
2,000,000 x 0.25 = 500,000 or 0,5 mil retic/microliter.
What two blood parameters can be useful guides for supposing an anemia is hemolytic?
An anemia with an increased plasma protein indicates potential hemolysis.
Additionally, a reticulocyte index over 3 (meaning markedly regenerative) is more often seen in hemolytic anemias since all the iron and protein is retained in the body to allow maximum erythroid regeneration.
Some early blood loss anemias will also have a RI over 3 so neither the RI or plasma protein are absolute indicators but are useful guides.
EIM and cryptorchid dog
estrogen-induced myelotoxicity
endogenous estrogen sources such as functional Sertoli cell or ovarian granulosa cell tumors may cause bone marrow toxicity in dogs. The condition is characterized by hematologic abnormalities including thrombocytopenia, anemia, and leukocytosis or leukopenia.
(retained) testicular estrogen-producing neoplasm can cause primary bone marrow disease presenting with thrombocytopenia and non-regenerative anemia, together referred to as a bicytopenia
Left shift described as degenerative when
banded neutrophils exceed segemented
steroids prolong the half-life of
neutrophils (neutrophilic hypersegmentation)
