Laboratory results, differentials and changes Flashcards
What is, what is the micropic appearance and what are the differentials for Asinocytosis?
Anisocytosis
What it is: Presence of RBCs of unequal size.
Microscopic appearance: Variably sized RBCs; can range from smaller to larger than normal RBCs.
Differentials:
Iron deficiency anemia (often with microcytosis and hypochromia)
Vitamin B12 deficiency or folate deficiency (macrocytosis)
Thalassemia (microcytic, hypochromic RBCs)
Chronic blood loss (microcytic, hypochromic)
What is, what is the micropic appearance and what are the differentials for Poikilocytosis?
What it is: Abnormal shapes of RBCs.
Microscopic appearance: RBCs with varied shapes (e.g., teardrop cells, sickle cells, target cells, spur cells).
Differentials:
Sickle cell anemia (sickle-shaped RBCs)
Hereditary spherocytosis (spherical RBCs)
Iron deficiency anemia (teardrop-shaped RBCs)
Thalassemia (target cells, basophilic stippling)
What is, what is the micropic appearance and what are the differentials for spherocytes?
What it is: Small, spherical RBCs with reduced central pallor.
Microscopic appearance: Spherical, lacking central pallor, and more dense.
Differentials:
Hereditary spherocytosis
Autoimmune hemolytic anemia (AIHA)
Hemolytic anemia (especially warm antibody type)
What is, what is the micropic appearance and what are the differentials for Target cells (codocytes) ?
What it is: RBCs with a bullseye appearance, increased central pallor.
Microscopic appearance: RBCs with a dark central area surrounded by a pale ring and then a dark outer rim.
Differentials:
Thalassemia Liver disease Iron deficiency anemia Hemoglobinopathies
What is, what is the micropic appearance and what are the differentials for sickle cells ?
What it is: RBCs shaped like a crescent or sickle.
Microscopic appearance: Crescent or sickle-shaped RBCs, often with irregular contours.
Differentials:
Sickle cell disease (Homozygous sickle hemoglobin, HbSS)
Sickle cell trait (heterozygous for HbS)
What is, what is the micropic appearance and what are the differentials for reticulocytes ?
What it is: Immature RBCs containing residual ribosomal RNA.
Microscopic appearance: Larger than mature RBCs, with a bluish tint or a reticular (network-like) pattern due to RNA.
Differentials:
Acute blood loss (e.g., trauma, surgery)
Hemolytic anemia (increased reticulocyte count)
Recovery from iron or vitamin B12 deficiency
What is, what is the micropic appearance and what are the differentials for basophilic strippling ?
What it is: RBCs with small, fine blue granules.
Microscopic appearance: RBCs with punctate blue granules throughout the cytoplasm.
Differentials:
Lead poisoning
Thalassemia
Alcoholism
Sideroblastic anemia
What is, what is the micropic appearance and what are the differentials for Howell-Jolly Bodies ?
What it is: Small, round remnants of nuclear DNA.
Microscopic appearance: Single, round, purple-staining bodies within RBCs.
Differentials:
Post-splenectomy
Severe anemia
Sickle cell disease
What is, what is the micropic appearance and what are the differentials for Howell-Jolly Schistozoites ?
What it is: RBC fragments caused by mechanical damage.
Microscopic appearance: Irregularly shaped, often jagged or triangular RBC fragments.
Differentials:
Microangiopathic hemolytic anemia (MAHA)
Thrombotic thrombocytopenic purpura (TTP)
Disseminated intravascular coagulation (DIC)
Hemolytic uremic syndrome (HUS)
What is, what is the micropic appearance and what are the differentials for Monocytosis ?
Monocytosis
What it is: Increased monocytes.
Microscopic appearance: Increased number of monocytes, larger and more abundant cytoplasm than lymphocytes.
Differentials:
Chronic infections (e.g., tuberculosis, endocarditis)
Autoimmune diseases
Myelodysplastic syndromes
Leukemia
what is a left shift?
A left shift refers to the presence of immature neutrophils (often bands or metamyelocytes) in the peripheral blood, which occurs when there is an increased demand for neutrophils due to infection or inflammation. It indicates that the bone marrow is releasing neutrophils into the bloodstream before they have fully matured.
what are key charachteristics of a left shift?
when do you see this?
Immature neutrophils (bands, metamyelocytes, myelocytes) are found in the peripheral blood, alongside mature neutrophils.
Associated conditions: Typically occurs in bacterial infections, severe inflammation, or bone marrow stimulation.
Neutrophil count: The total neutrophil count (including both mature and immature neutrophils) is often elevated
what is the microscopic appearance of a left shift?
Bands (neutrophils with a band-shaped nucleus) are the most common form.
In severe left shifts, you may also see metamyelocytes (nucleus less elongated than bands) and myelocytes (larger, with a rounder nucleus).
what are differentials for a left shift?
Bacterial infections (especially severe or overwhelming infections)
Abscesses
Severe inflammation
Leukemoid reaction (reactive, marked neutrophilia)
what is a stress leukogram?
A stress leukogram is a pattern of changes in the WBC count that reflects an acute stress response, typically due to corticosteroid release (either from the adrenal glands or exogenously administered corticosteroids). It is seen in conditions like physical stress, trauma, infection, or when corticosteroids are used as medication.
what are key charachteristics of a left shift?
Neutrophilia: An increase in neutrophil count, but without a significant increase in immature forms (no left shift).
Lymphopenia: A decrease in the number of lymphocytes.
Monocytosis: An increase in monocytes (less prominent than neutrophilia).
Eosinopenia: A decrease in eosinophils.
Microscopic appearance: There are no immature neutrophils (bands or metamyelocytes) in the blood smear.
what are differentials for a left shift?
Acute stress (e.g., physical trauma, surgery)
Corticosteroid therapy (either endogenous, like in Cushing’s disease, or exogenous)
Severe illness or systemic inflammation (e.g., sepsis)
Acute myocardial infarction
how to tell a left shift appart from a stress leukogram
. Immature Neutrophils:
Left shift: There will be a significant presence of immature neutrophils, such as bands, metamyelocytes, or myelocytes. Stress leukogram: There will be no immature neutrophils; neutrophils will be mature forms only.
- Neutrophil Count:Left shift: The neutrophil count will often be elevated, but with a high proportion of immature neutrophils.
Stress leukogram: The neutrophil count will also be elevated, but the neutrophils will be mostly mature, without a significant increase in immature forms. - Other WBC Components:Left shift: There is typically no marked change in lymphocytes or monocytes (though slight changes may be seen).
Stress leukogram: Lymphopenia (low lymphocytes) and monocytosis (increased monocytes) are typical features. Eosinopenia (low eosinophils) is also often seen in a stress leukogram. - Clinical Context:Left shift: More commonly seen in acute bacterial infections, inflammatory conditions, or severe infection.
Stress leukogram: Seen in response to physical or emotional stress, corticosteroid use, trauma, or acute systemic illness. It is more of a physiologic response to stress rather than an indicator of active infection or inflammation.
what is a transudate and what are the criteria that this must have?
Transudates are caused by imbalances in hydrostatic or oncotic pressure and are generally due to systemic conditions. They have low protein content and are typically clear and pale yellow.
Microscopic Features: Few cells, primarily macrophages, mesothelial cells, and lymphocytes. Occasionally, there may be neutrophils if mild inflammation is present.
what is an exudate
Exudates result from local inflammation, infection, or malignancy. They are typically high in protein and can be cloudy, yellow, or even bloody in appearance.
Often contains neutrophils (if bacterial infection), lymphocytes (if viral or neoplastic), and macrophages. Mesothelial cells may also be present.
compare transudate, modified transudate, exudate and septic exudate
Differentials for anaemia
HypoT
HypoA
Prolonged bleeding
Chronic renal failure (mild🡪life threatening) – ↓ EPO, toxic depression of BM, ↑RBC fragility
Secondary to inflammation ->Enhanced hemolysis
Utilisation of iron by bacteria
differentials for increased basophils
Concurrent w/ eosinophils in hypersensitivity disorders
Hyperlipoprotieinaemia
- DM
- Nephrotic syndrome
- Chronic liver dz
- Hypo-T
Some respiratory and skin disease
Mast cell tumors
Granulocytic leukemia
Heartworm disease or other systemic parasites
Differentials for increased eosinophils
Hyper-sensitivity disorders
Histamine release (allergic diease, mast cell Neoplasia, paraneoplastic diease)
Antigenic stimulation (sensitised by T-cells: hypersensitivity, migrating parasites)
Oestrus – esp bitch
Dz of the respiratory system, skin, GIT, female urogenital system
Hypo-A
Metastatic neoplasia