Leukocytes Part 2 Flashcards
“Penia” means?
= (decreased) concentration of cells cytopenia
“philia” or “cytosis” means?
= increased concentration
What is a left shift?
What cells are present?
Which condition does this phenomenon occur in?
“Left shift”
* Increased concentration of IMMATURE neutrophils in the blood
* Usually band N0, but may include metamyelocytes)
* Occurs with Neutrophilia, normal concentration of N0 or Neutropenia
* If w/neutropenia, more severe inflammatory response
What is orderly maturation?
“Orderly” Matura.on
§ Concentration of each cell increases with the degree of maturity.
§ In other words, if a left shi9=ft is orderly, there should be more bands than
metamyelocytes, and more segmented neutrophils than bands.
§ IF it is disorderly, consumption is very severe, or a neoplastic process is
present (leukemia).
What is leukemia?
Leukemia
* Presence of neoplastic cells in the blood or bone marrow.
* Concentration of neoplastic cells in the blood can be quite variable,
from non-detectable to > 500,000/μl.
Can vary; in periphal blood, we may seen none
Pure erythroid leukemia
What is the difference between lymphoprolfierative and myeloprolifeatie disorders?
- Lymphoproliferative disorders
* Neoplasms of Lymphocytes & Plasma cells - Myeloproliferative disorders
* Neoplasms arising from bone marrow stem cells and involve N0, monocytes, erythrocytes, and rarely, E0 and basophils
How do we obtain a WBC count?
- Obtained by automated methods (hematology
analyzers) in most species as part of a routine CBC - Some automated analyzers count all nucleated cells as
WBCs- If many nRBCs present, may need a correction factor
- Manual counting by hemocytometer used for
avian/exotics- Automated counting not reliable due to nucleated RBCs
What errors do we commonly see in WBC counts?
- FALSE decreased WBCs
* Leukocyte clumping
* Leukocyte lysis (common with delayed analysis of the sample/was not stored properly; if stored in ambient temperature for 6-8 hours) - FALSE increased WBCs
* Abnormally large platelets, or platelet clumps
* High numbers of Heinz bodies
* High numbers of nRBCs
How do you obtain a Total WBC count?
*WBC count from blood smear
* Inaccuracy
* Uneven cell Distribution
* Quality of the smear preparation
What is the leukocyte differential?
- Concentra)ons of each leukocyte type (% and absolute counts) are
reported by automated hematology analyzers - Manual differen)al count is obtained from a stained blood smear
- Always a good idea to do this and ensure that your instrument is coun)ng
cells correctly - Allows you to simultaneously evaluate leukocyte morphology and check for
any organisms
- Always a good idea to do this and ensure that your instrument is coun)ng
Absolute Counts vs Percentages
* Interpretation should be done based on the ABSOLUTE count of a cell
and not the percentages
* WHY? ABSOLUTE counts have established reference intervals
* More accurate
Neutrophilia/Heterophilia –> Increased absolute counts on CBC
2 scenarios in which this can occur:
1. Physiologic (in normal events; e.g. animal is sick)
* Also see Lymphocytosis,
- No Left shift
2. Corticosteroid-induced (Stress)
- Also have Lymphopenia
- No left shift
3. Inflammatory
* Should have Left shift or a N0 concentration > tht will likely be 2x upper limit RI
In a case of physiologic neutrophilia/heterophilia, _________ is released due to fear, excitement, fright. This mobilizes _________ neutrophils to move into the __________ neutrophils pool.
Concurrent __________ (most prominent feature in feline excitement response.)
* ____________ are released from the thoracic duct and stay in circulation.
This is common in young _____, _____, and _____, seldom in ____
- Transient: __-____ min then go back to normal
Physiologic neutrophilia/Heterophilia
- Release of epinephrine
* From fear, excitement, fright
- Epinephrine –> mobilization Marginated neutrophils pool
to the Circulating neutrophils pool
- Concurrent Lymphocytosis (most prominent feature in feline excitement response.)
* Lymphocytes stay in circulation
* Lymphocytes released from thoracic duct
- Common in young cats, horses, cattle
* Seldom in dogs
- Transient ~20-30 min then go back to normal
Stress/corticosteroid neutrophilia/heterophilia occurs due to the presence of endogenous/exogenous _____________. This is seen in cases of illness, pain, or metabolic disturbances.
Concomitantly, have ________ (?)
* Lymphocytes are sequestered in ___________ _______)
* +/- ___________, _________ (dogs)
- Corticosteroids endogenous or exogenous induced
- See in illness, pain, metabolic disturbances
- Treated w Corticosteroid
- Corticosteroid producing tumors
- Concomitantly to the neutrophilia (2x upper RI)
- have lymphopenia (stress leukogram)
- Lymphocytes are sequestered in Lymphoid $ssue)
- eosinopenia, monocytosis (dogs)
Avoid confusing neutrophilia of stress with inflammation
Inflammatory neutrophilia/Heterophilia occurs due to both __________ and __________ causes. ___________ depend on etiology. Infectious agents: stimulate release of (3?). Granulocytic precursor Stem Cells in bone marrow are stimulated to produce ______
Neutrophils (N0).
You will see..
–> ______ _____ (OFTEN)
• Increased _____ neutrophils
• Parallels degree of inflammation
–> or see _____ than 2x Upper Reference Interval
• Rate of Neutrophils release from bone marrow and rate of neutrophils usage in tissues
• faster use of of neutrophils than production may -> ________
- Infectious and non-infectious causes.
- Mechanisms depend on etiology
- Infectious agents: stimulate release of IL, Growth factors, Cytokines
- Granulocytic precursor Stem Cells in bone marrow are stimulated to produce MORE
Neutrophils (N0)
• Left shift (OFTEN)
• Increased band neutrophils
• Parallels degree of inflammation
• or see Greater than 2x Upper Reference Interval
• Rate of Neutrophils release from bone marrow and rate of
neutrophils usage in @ssues
• faster use of of neutrophils than produc@on may –> Neutropenia
Neutropenia
Inflammatory neutrophilia/Heterophilia
- Left shift (OFTEN)
- Increased band neutrophils
- Parallels degree of inflammation
- or see Greater than 2x Upper Reference Interval
- Rate of Neutrophils release from bone marrow and rate of
neutrophils usage in @ssues - faster use of of neutrophils than production may –>
This will be a severe, overwhelming inflammation
What patterns are commonly seen in cases of
Inflammatory neutrophilia/Heterophilia?
- left shift = increase in immature neutrophils present
- a lot of neut moe than RI that are more than 2 x
- veyr low count of mature neut and let shift = immauture neut
Species differences
* Cattle: ________ neutrophil storage pools in bone marrow than other species (_____, _______, _________)
*Neutrophils are depleted _____ after emigrating to tissues
smaller, dog, cats, horses, faster
In cases of extreme neutrophilia,
- Those cases with >________/uL think of:
- The ”_______ ____”: ?
- Leukocyte ________ deficiency (_____, ______)
*_____________ (dogs) - ________
- _________ disorders
Extreme neutrophilia
* Those cases with >50,000/uL think of:
* The ”five Ps”: Pyometra, pyothorax, pancreaBBs, peritoniBs, pneumonia
* Leukocyte adhesion deficiency (dogs, caFle)
* Hepatozoonosis (dogs)
* IMHA
* NeoplasBc disorders
Hepatozoon spp
Neutropenia/Heteropenia is defined as the _________ absolute counts on CBC
Seen in cases of…
* _________
* Severe ________
*________-Mediated destruction (Rare)
* Decreased production by _______ _____
Decreased
Endotoxemia
Inflammation
Immune
bone marrow
Neutropenia/Heteropenia caused by Endotoxemia occurs due to the global activation of _________ responses which induces a shift of neutrophil pools from ____ to ___
- global activation of inflammatory responses
- Induces shift of neutrophil pools from CNP to MNP
Neutropenia/Heteropenia caused by Severe inflammation occurs due to excessive ______ demand for neutrophils – rate of ________ into tissues exceeds rate of _______ ______ production. There is often a concurrent severe _____ ______ + _______ toxicity and/or _______ lymphocytes on blood smear evaluation
* Causes: (2?)
- Excessive tissue demand for neutrophils – rate of emigration into
tissues exceeds rate of bone marrow production - Often a concurrent severe left shift
- Neutrophil toxicity and/or reactive lymphocytes on blood smear evaluation
- Causes:
- Endotoxemia
- Bacteria
Neutropenia/Heteropenia caused by Decreased bone marrow production occurs due to?
- Drugs and toxins
* Radiation
* Cytotoxic chemotherapeutic drugs
* Estrogen toxicosis
* Bracken fern poisoning - Infectious agents
* Viruses (FeLV, FIV, canine parvovirus, FIP)
* Disseminated fungal infections
* RickeEsial disease - Bone marrow disorders
* Necrosis
* Myelofibrosis
* Myelodysplastic syndrome/neoplasia
- Physiologic Lymphocytosis occurs in which species?
- This condition is _______-mediated
- You will typically see concurrent _____
- Cats, cattle, horses
- Epinephrine
- neutrophilia
Chronic antigen stimulation Lymphocytosis is a complication of which two tick borne diseases?
It also can be caused by what other diseases/infection?
- Rocky Mountain spotted fever (Rickettsia rickettsia), canine
monocytic erlichiosis (Ehrlichia canis) - Chronic bacterial, viral, fungal or parasitic infections
Persistent lymphocytosis in cattle is caused by? Explain the pathogenesis?
Describe the different versions of this disease.
- Bovine Leukemia Virus infection
- Virus promotes B-lymphocyte hyperplasia
* Subclinical, non-neoplastic
This is an oncogenic retrovirus that when it infects lymphocytes, it induces them to proliferate and results in persiten lymphocyts swhich is the benign form of disease or you may have neoplasitc tumors that invade differen organs –> diseasd is called enxootic bovine leukosis or lymphosarcoma.
Lymphocyte leukemia
In cases of Corticosteroid-induced Lymphopenia, you may or may not see (+/-) ?
What will you always see in a stress leukogram?
This condition is common in which species?
- Concurrent neutrophilia , monocytosis and eosinopenia
- No always see the above concurrently
- Concurrent neutrophilia , monocytosis and eosinopenia
- Always see lymphopenia in Stress leukogram!
- Lymphopenia is always seen
- # 1 Criteria for a stress leukogram
- Common in dogs
Lymphopenia can occur due to _____ or ____ infections. Are these infections acute or chronic?
viral, bacterial
Acute, and im sure chronic too
Which immunodeficiencies can lead to lymphopenia?
- Immunosuppressive therapy or irradiation
- Loss of lymphocyte-rich-lymph
- Chylothorax
- Intestinal lymphangiectasia
- Hereditary immunodeficiency
- Severe combined immunodeficiency (SCID) –foals-
When does monocytosis occur?
Occurs in conjunction with neutrophilia in cases of:
* inflammation
* Corticosteroid-induced (stress)
Monocytosis cna be seen in…
* Bacteremia
* Necrosis
* Neoplasia
* Hemolysis
* Hemorrhage
* Immune-mediated disease
* Pyogranulomatous disease (fungal, parasi<c infec<ons)
Eosinophilia
Eosinophilia can occur due to?
- Parasitism
- Hypersensitivity
- Lesions producing eosinophil chemoattractants, such as mast cell tumor
- Specific examples: heart worms, hook worms, dermatitis, asthma, etc
- Eosinophilic leukemia
Basophilia
Basophilia is often seen with concurrent ________ and/or increased circulating _____ cells (________). Often seen in cases of?
* _________/________ reactions
* ______ infections
* Basophilic _______
eosinophilia, mast, mastocytemia
Allergic/hypersensitivity
Parasitic, leukemia
Mastocytemia
* Increased numbers of mast cells in the blood
* More clinically significant in cats vs. dogs
* Reactive (inflammatory) conditions
* Enteritis (parvovirus)
* Pleuritis
* Peritonitis
* Neoplastic disorders
* Systemic mast cell disease – progressive from cutaneous or visceral mast cell
neoplasia
* Mast cell leukemia (rare)
