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LCB2 > Leucogram > Flashcards

Leucogram Flashcards

1
Q

What is the myeloid?

A

Bone marrow

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2
Q

Outline the development of neutrophils

A
  • In the bone marrow, occasionally extramedullary haematopoiesis (spleen, liver, other)
  • Myeloblast -> progranulocyte -> myelocyte -> prolferation and maturation -> metamyelocyte -> band -> segmented neutrophil -> maturation
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3
Q

What is meant by “left shift”?

A

More immature neutrophils seen

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4
Q

Outline the movement of mature neutrophils to death

A
  • Neutrophil maturation
  • Period storage followed by circulation
  • Will either be in middle of vessel or towards wall of the vessels (marginated)
  • After margination, out of the vessel
  • Hypersegmentation and death
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5
Q

What are the steps required for neutrophils to leave blood vessels?

A
  • Marginalisation
  • Adhesion
  • Migration
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6
Q

What factors may produce a shift from marginal to circulating pool of neutrophils?

A
  • Epinephrine
  • Infection
  • Stress
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7
Q

What allows the adherence of neutrophils onto cell walls and migration through the wall?

A

Binding selectin receptors on blood vessels to ligands on cell walls

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8
Q

Compare the proportions of the marginal and circulating pool of neutrophils in the dog and cat

A
  • 50:50 in dogs

- Cat: 25-50% circulating, 50-75% marginal

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9
Q

What is the effect of glucocorticoids on vessel wall adhesion of neutrophils?

A

Causes neutrophils to stick to walls less i.e. demarginalise and age in the circulating pool

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10
Q

Compare the circulation of lymphocytes and neutrophils

A

Recirculation occurs with lymphocytes, but not with neutrophils

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11
Q

Compare the appearance of equine lymphocytes to those of dogs

A

Dogs: small cells with round nuclei, smooth dense chromatin, small rim of blue cytoplasm
- In horse: slightly larger, finer, looser chromatin pattern

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12
Q

Describe the lymphocytes found in ruminants

A
  • variable in appearance
  • many are large lymphocytes
  • Loosely clumped chromatin
  • Fairly abundant cytoplasm
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13
Q

Describe the appearance of reactive lymphocytes

A
  • Larger cells
  • Coarse (mature) chromatin
  • Deep blue cytoplasm
  • Aka immunocytes
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14
Q

Describe the appearance of granular lymphocytes

A

Distinguished by small pink granules collected into one area of the cytoplasm

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15
Q

What may cause variation in the shape of lymphocytes?

A
  • Mechanical forces applied during smearing

- Molded by contact with red cells

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16
Q

Describe the appearance of feline monocytes

A

Often look like a “splat” with cytoplasmic vacuolation and some tinge to cytoplasm

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17
Q

What aspects of haematology are included in the erythron?

A

Red blood cells, haemoglobin, haematocrit/PCV, MCV, MCHC

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18
Q

What aspects of haematology are included in the leukon?

A
  • Total WBC
  • Neutrophils
  • Lymphocytes
  • Monocytes
  • Eosinophils
  • Basophils
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19
Q

What aspects of haematology are included in the thrombon?

A

Platelet count

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20
Q

Describe the characteristics of leukocytosis

A
  • Neutrophilia
  • Lymphocytosis
  • Monocytosis
  • Eosinophilia
  • Basophilia
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21
Q

Describe the characteristics of leukopaenia

A
  • Neutropaenia
  • Lymphopaenia
  • Monocytopaenia
  • Eosinopaenia
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22
Q

What are the potential causes of altered WBC number and morphology?

A
  • Infection
  • Inflammation and endocrine
  • Lymphoid and myeloid neoplasia
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23
Q

What does neutropaenia indicate in horses and cattle and why?

A

Inflammation - neutrophil count dependent on what is being taken out, less produced than taken out indicates inflammation

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24
Q

List the potential causes of neutrophilia

A
  • Inflammation
  • Immune mediated anaemia
  • Necrosis
  • Steroid
  • Physiological (stress)
  • Chronic neutrophil leukaemia
  • Paraneoplastic
  • Others e.g. LAD
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25
Q

Explain how steroids lead to neutrophilia

A
  • Stress, steroid therapy, HAC
  • Increase release of marrow storage pool cells
  • Increase demargination of neutrophils by reducing stickiness to the wall so increase circulating pool
  • Prevent extravasation by reducing the stickness
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26
Q

What characteristics indicate that a neutrophilia is due to steroids?

A

Hypersegmented cells seen in blood due to aging of cells in circulating pool i.e. right shift

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27
Q

Give examples of paraneoplastic causes of neutrophilia

A
  • Rectal polyp
  • renal tubular carcinoma
  • Metastatic fibrosarcoma
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28
Q

Explain how LAD leads to neutrophilia

A
  • Leukocyte adhesion deficiency
  • Will not stick to vessel walls due to lack of adhesion molecules
  • Stay in circulation
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29
Q

What may cause increased release of the marrow storage pool of neutrophils?

A
  • endotoxaemia
  • Acute infection
  • Hypoxia
  • Glucocorticoids
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30
Q

What may cause expansion of the marrow precursor pool of neutrophils?

A
  • Chronic infection of inflammation
  • Tumours
  • Rebound from neutropaenia
  • Myeloproliferative disorders
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31
Q

Describe what is meant by a stress leukogram

A

Low lymphocyte, high neutrophil

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32
Q

List the causes of neutropaenia

A
  • Inflammation (peracute/overwhelming bacterial infections, canine and feline parvo)
  • Decreased production: infections, toxicity, neoplasia (leukaemia, myelodysplastic, metastasis), marrow necrosis, myelofibrosis
  • Rarely: Immune mediated neutropaenia, Chediak Higashi, acyclic haematopoiesis in grey collies, canine hereditary neutropaenia
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33
Q

In a case of neutropaenia, what is the most likely cause if there is no anaemia, platelets are adequate, and a left shift is present?

A

Acute inflammation

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34
Q

In a case of neutropaenia, what is the most likely cause if there is no anaemia, platelets are adequate, and a left shift is not present?

A
  • Acute viral infection

- Acute marrow injury

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35
Q

In a case of neutropaenia, what is the most likely cause if there is any combination of: non-regenerative anaemia, thrombocytopaenia, presence of neoplastic cells?

A

Chronic marrow injury

36
Q

How should neutropaenia in acute inflammation in the dog or cat be interpreted?

A

Very severe lesion

37
Q

How should neutropaenia in acute inflammation in the horse be interpreted?

A

Probably severe lesion

38
Q

How should neutropaenia in acute inflammation in the cow be interpreted?

A

Neutropaenia typical in inflammation regardless of severity

39
Q

Describe the marrow reserve, regenerative capacity, typical reference interval, typical inflammatory values and uncommon neutrophil counts in dogs

A
  • Reserve: relatively high
  • Regen: rapid
  • Typical: 3.0-11x10^3/ul
  • Inflammation: 12-30x10^3/ul
  • Uncommon: >60x10^3uk
40
Q

Describe the marrow reserve, regenerative capacity, typical reference interval, typical inflammatory values and uncommon neutrophil counts in cats

A
  • Reserve: intermediate
  • Regen: intermediate
  • Typical: 2.0-12.5x10^3/ul
  • Inflammation: 13-25x10^3/il
  • Uncommon: >40x10^3/ul
41
Q

Describe the marrow reserve, regenerative capacity, typical reference interval, typical inflammatory values and uncommon neutrophil counts in horses

A
  • Reserve: intermediate
  • Regen: intermediate
  • Typical: 2.2-8.6x10^3/ul
  • Inflammation: 9-20 x10^3/ul
  • Uncommon: >30x10^3/ul
42
Q

Describe the marrow reserve, regenerative capacity, typical reference interval, typical inflammatory values and uncommon neutrophil counts in cattle

A
  • Reserve: relatively low
  • Regen: slow
  • Typical: 0.6-4x10^3/ul
  • Inflamm: 4-10x10^3/ul
  • Uncommon: >20x10^3/ul
43
Q

Describe the appearance of reactive lymphocytes

A
  • Increased cytoplasmic basophilia
  • Perinuclear halo
  • Prominent golgi zone (clear are)
  • Larger, eccentric, cleavednucleus
  • More medium and large vs. peripheral blood small lymphocytes
44
Q

What are the potential causes of lymphocytosis?

A
  • Catecholamine mediated via splenic contraction (physiological)
  • Chronic inflammation
  • Young animals and recent vacciantion
  • Lymphoproliferative disorder e.g. FeLV, BLV,
  • Hypoadrenocorticism
45
Q

What are the potential causes of lymphopaenia?

A
  • Stress/steroid
  • Acute inflammation
  • Loss of lymph
  • Cytotoxic drugs, radiation
  • Immunodeficiency syndrome
  • Lymphoma (LN pathology an disrupted circulation)
46
Q

How does stress/steroid lead to lymphopaenia?

A
  • Endogenous/exogenous, incl stress of being unwell

- Shifts lymphocytes of of circulation and lymphocytolysis

47
Q

Explain how loss of lymph can lead to lymphopaenia

A

Chylothorax or lymphangiectasia, meaning circulation is not getting back to the blood

48
Q

Explain how cytotoxic drugs or radiation may lead to lymphopaenia

A

Damage to production of lymphocytes/disruption of the circulation

49
Q

What may cause monocytosis?

A
  • Inflammation: infectious, necrosis, haemolysis, haemorrhage, neoplasia, infarction, trauma
  • Steroid/stress
  • Monocytic.myelomonocyti c leukaemia
50
Q

What is the importance of monocytopaenia?

A

None - no level of monocytes below which we worry

51
Q

What are teh potential causes of eosinophilia?

A
  • Hypersensitivity
  • Parasitism
  • Hypoadrenocorticism
  • Paraneoplastic
  • Idiopathic eosinophilic syndromes
  • Eosinophilic leukaemia (v rare)
52
Q

Give examples of idiopathic eosinophilic syndromes

A
  • Canine eosinophilic bronchopneumopathy
  • Myositis
  • Feline eosinophilic granuloma
53
Q

What may cause eosinopaenia?

A

Glucocorticoids, stress, inflammation

54
Q

Compare the sensitivity to glucocorticoids of eosinophils and lymphocytes

A

Eosinophils more sensitive

55
Q

List potential cuases for the presence of nucleated red cells

A
  • Regenerative anaemias
  • Lead toxicity
  • EMH and splenic contraction
  • Damaged marrow
  • Inappropriately high numbers: erythroleukaemia (e.g. erythemic myelosis in cats)
56
Q

Describe the characteristics of a regenerative left shift

A
  • Segmented > immature

- Neutrophil count increased

57
Q

Describe the characteristics of a degenerative left shift

A
  • Immature > segmented
  • Neutrophil count the same, decreased or increased
  • Indicates inability/difficulty to keep up with demand
58
Q

What may cause neutrophil toxic change?

A
  • Usually severe bacterial infection
  • Parvo
  • IMHA
  • ARF
  • DIC
  • Neoplasia
59
Q

What does neutrophil toxic change indicate?

A

High neutrophil demand

60
Q

Describe the potential appearance of neutrophil toxic change

A
  • Foamy cytoplasm: dispersed organells (not discrete)
  • Diffuse cytoplasmic basophilia
  • Doehle bodies: focal blue-grey cytoplasmic structure (RER, RNA)
  • Asynchronous nuclear maturation: finely granular nuclear chromatin but in segments
61
Q

What are toxic changes in neutrophils?

A

Morphologic abnormalities acquired during maturation under conditions that intensely stimulate neutrophil production and shorted the maturation time in the marrow

62
Q

What do most toxic neutrophil changes occur as a result of?

A

Asynchronous maturation between nucleus and cytoplasm

63
Q

Describe the normal process of granulocytopoiesis

A
  • Lengthening and pinching of nucleus are coordinated with progressive condensation of chromatin and loss of cytoplasmic basiphilia
  • Produces white cytoplasm with pink granules, long and fairly narrow nuclei and tightly condensed chromatin
64
Q

Describe the different appearances of cytoplasmic basophilia in neutrophil toxic change

A
  • Focal: pale blue spots = Doehle bodies (aggregated ribosomes and whorls of RER)
  • Streaked
  • Diffuse:
65
Q

What causes the frothy/vacuolated cytoplasm seen in neutrophilic toxic change?

A

Degranulation of lysosomes

66
Q

List examples of neutrophil inclusions

A
  • Bacterial: Ehrlichia, Anaplasma
  • Viral: canine distemper
  • Protozoa: toxoplasma, hepatozoon
  • Fungi: histoplasma
  • Hereditary/metabolic: Chediak-Higashi, Birman cat anomaly, mucopolysidosis
67
Q

What are heterophils?

A

Functional equivalent to neutrophils in which the granules stain red. Found in rabbits, reptiles, birds

68
Q

Outline the use of WBC differential % and WBC absolutes

A
  • % only for calculation of absolutes

- Absolutes should be used for comparison against reference intervals for clinical purposes

69
Q

Describe the leukogram pattern associated with excitement

A
  • Mature neutrophilia )2x dogs, horses and cows, >2x in cats)
  • Lymphocytosis esp. cats
70
Q

Describe the leukogram pattern associated with steroid/stress

A
  • Mature neutrophilia
  • Lymphopaenia
  • Eosinopaenia
  • +/- monocytosis
71
Q

How can total leukocyte count be measured manually?

A

Haemocytometer

72
Q

What are the different techniques for the machine measurement of total leukocyte count?

A
  • Impedance
  • Laser
  • Combined laser and impedance
  • Multichannel laser
73
Q

Which machine technique is best for the counting and sizing of leukocytes?

A

Impedance - measures change in voltage across receptor to give count and size (degree of change)

74
Q

Which machine technique is best for the differentiation of leukocytes?

A

Laser (assess intracellular complexity and lobularity)

75
Q

List the main disadvantages of automated leukograms

A
  • Non count bands, other WBC precursors or nRBCs
  • None report toxic change
  • None report WBC inclusions
  • None specifically report atypical or reactive morphology
  • Bands and metamyelocytes may be miscounted as monocytes
76
Q

Which is the most reliable method for automated leukograms?

A

Impedance

77
Q

Describe the typical acute inflammatory leukogram pattern

A
  • Total WBCs increased
  • Segmented neutrophils increased
  • Non-segmented neutrophils increased
  • Lymphocytes decreased
  • Monocyte normal to increased
  • Eosinophils low to normal
78
Q

Describe the typical chronic inflammatory leukogram pattern

A
  • Total WBCs increased
  • Segmented neutrophils increased
  • Non-segmented neutrophils normal to increased
  • Lymphocytes normal to increased
  • Monocyte normal to increased
  • Eosinophils normal
79
Q

Describe the typical steroid leukocytosis leukogram pattern

A
  • Total WBCs increased
  • Segmented neutrophils increased
  • Non-segmented neutrophils normal to slight increase
  • Lymphocytes low
  • Monocyte increased
  • Eosinophils low
80
Q

Describe the typical physiologic leukocytosis leukogram pattern

A
  • Total WBCs increased
  • Segmented neutrophils increased
  • Non-segmented neutrophils normal
  • Lymphocytes increased
  • Monocyte normal to increased
  • Eosinophils normal
81
Q

Describe the typical acute overwhelming inflammatory leukogram pattern

A
  • Total WBCs low
  • Segmented neutrophils low
  • Non-segmented neutrophils normal to increased
  • Lymphocytes low
  • Monocyte normal
  • Eosinophils low to normal
82
Q

Describe the typical acute inflammatory with endotoxaemia leukogram pattern

A
  • Total WBCs low
  • Segmented neutrophils low
  • Non-segmented neutrophils normal to increased
  • Lymphocytes low
  • Monocyte normal
  • Eosinophils low to normal
83
Q

Describe the typical granulocytic hypoplasia leukogram pattern

A
  • Total WBCs low
  • Segmented neutrophils low
  • Non-segmented neutrophils normal
  • Lymphocytes normal
  • Monocyte normal
  • Eosinophils normal
84
Q

Describe the typical ineffective neotropoiesis leukogram pattern

A
  • Total WBCs low
  • Segmented neutrophils low
  • Non-segmented neutrophils normal
  • Lymphocytes normal
  • Monocyte normal to increased
  • Eosinophils normal
85
Q

Describe the typical hypoadrenocorticism leukogram pattern

A
  • Total WBCs normal
  • Segmented neutrophils low o normal
  • Non-segmented neutrophils normal
  • Lymphocytes normal to increased
  • Monocyte normal
  • Eosinophils normal to increased
86
Q

Describe the typical haemic neoplasia leukogram pattern

A
  • Total WBCs hugely increased

- Cell line affected expected to be increased, other cell lines typically normal or decreased

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