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
