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RBC morphology Flashcards

1
Q

Morphology of normal mammalian erythrocytes

A

Varies among species
Canine- biconcave disc shape with a distinct area of central pallor
Feline- round with little or no central pallor
Avian, reptiles, amphibians, and fish all have nucleated RBCs
Camellidae family have elliptical RBCs

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2
Q

Procedure for reporting RBC morphology

A

Under high dry (40x) find an appropriate monolayer area to evaluate (where you would perform your differential count)
Look for agglutination, reuleaux, parasites or an abnormal sized monolayer
Under oil immersion examine the erythrocytes for variations in size, shape, colour and the presence of inclusions

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3
Q

Morphological characteristics Categorized according to

A

Cell arrangement
Cell size
Cell colour
Cell shae
The presence of structures on or in the erythrocyte

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4
Q

Erythrocyte arrangement on blood smears: Rouleaux is

A

Is when the red blood cells appear in linear stack(like stocked coins)
A normal finding in horse
Cats and pigs will normally have a slight rouleaux
It can be an artefact if the blood has been stored too long before the smear is made, or it was refrigerated before a blood film was made
May be seen with increased total protein levels in the blood
Must be reported
Exception: rouleaux is not reported in the horse and is only reported in cats if it is 3+
Accompanied by an increase in erythrocyte sedimentation rate

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5
Q

Agglutination is and looks like

A

Results in irregular, spherical clumps of cells
In early stages, it may appear as increased rouleaux with some cells appearing to be connected by long, thin extensions of the RBCs cytoplasm
As it progresses, the cells will take on a muddy brown colour and “melted together” appearance
Occurs due to a reaction between antibodies (usually) and the antigens present on the surface of the RBCs

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6
Q

To differentiate rouleaux formation from true agglutination the following test can be performed

A

Mix a small amount of blood at a ratio of 50;50 with warm (or room temp) isotonic saline
Make a smear and stain as usual
If the formation disappears, it is due to a high total protein concern of the plasma
If agglutination is still visible, there is antibody involvement

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7
Q

Normocytic means

A

Cells of a normal size

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8
Q

Macrocytic means

A

Larger then a normal size cell

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9
Q

Microcytic means

A

Smaller then normal cells

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10
Q

Ansicytosis means

A

Variation in size
Common in cattle and rates therefore not reported

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11
Q

Macrocytic erythrocytes look like

A

Large in diameter, generally twice the size as normal
Dogs: erythrocytes only need to be slightly larger than normal to be classified as macrocytes
The cells have an increased MCV

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12
Q

Microcytic erythrocytes looks like

A

Smaller in diameter than normal
Often accompanied by hypochromasia
MCV will be lower than normal

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13
Q

RBCs should be what colour

A

RBCs are said to be normochromic when there are no abnormalities in cell colour
MCH (mean corpuscular hemoglobin) in normal
MCHC( mean corpuscular hemoglobin concentration) is normal

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14
Q

Polychromasia means

A

refers to a cell being darker in colour than normal

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15
Q

How to stain in order to see colour

A

Wright’s stain: appear as macrocytic, blue tinged red cells
They are immature RBCs
Blue staining is due to the presence of organelles within the cells

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16
Q

Polychromasia is important why and usually accompanied by

A

AN EXTREMELY IMPORTANT ELEMENT OF A PATIENT’S BLOOD PROFILE
Usually accompanied by
An increased number of nucleated RNCs
Hypersegmented neutrophils
Howell Jolly bodies

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17
Q

What does polychromasia indicate

A

Horses will release macrocytic RBCs that are not polychromatic
An increase indicates regenerative anemia→ good prognosis
A lack of macrocytic cells indicates a non-regenerative anemia→ poor prognosis

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18
Q

Hypochromasia look like

A

Cells are more pale in colour than normal
Increased central pallor
Due to a decreased hemoglobin concentration within the cell
Macrocytic RBCs can appear to be hypochromic because of enlarged cell size

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19
Q

Hypochromasia is caused by

A

Due to a decreased hemoglobin concentration within the cell
Can be due to poor smear technique
-Have what looks like a punched out center

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20
Q

What can hypochromasia indicate

A

Micrystosis often accompanies hypochromasia
-Iron deficiency

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21
Q

Hyperchromasia is

A

Cells that are stained darker than normal
RBC have a fixed maximum so versaturation is not possible
Hyperchromasia is usually seen spherocytes or microcytic cells

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22
Q

Erythrocyte shape can indicate

A

When describing the RBC shape, be as specific as possible
Certain shapes indicate specific diseases

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23
Q

Your role as a tech for erythrocyte shapes

A

Identify if abnormal cells are present
Name the abnormal cells
Quantify the abnormal cells

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24
Q

Schistocytes look like and are a result of

A

These are RBC fragments
They are generally the result of shearing the cell from intravascular trauma

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25
Echinocytes look like
Have short, evenly spaced, blunt to sharp surface projections that are uniform in size and shape Often an artefact from drying the slide too slowly, being refrigerated, or put in a hypertonic solution Can be due to pathological processes
26
Echinocytes are classified as and how to tell the difference
Echinocyte 1 (crenated cells)- very short projections Echinocyte 3 (Burr cells)- very thin, tall, quill like projections Projections are of equal length and are evenly spaced over the periphery of the cell
27
Acanthocytes look like
An irregularly, spiculated RBCs Have a few unevenly distributed surface projections of variable size and diameter Can be a normal finding in cattle There is often underlying pathology if they are present in large numbers in small animals
28
Drepanocytes look like and indicate
Look like smushed RBCs Also called sickle cells Normal finding in deer and angora goats
29
Keratocytes look like
These are RBC containing 2 or more spicules (long projections tha outlook like horns or crescents) May appear to contain a vacuole May appear in small numbers on blood smears from healthy animals
30
Sphyrocytes look like
Darkly staining RBCs that don't contain central pallor (appear to be hyperchromic) Smaller than normal RBCs with normal MCV Almost perfectly round Usually only detectable in dogs Seen with IMHA
31
Leptocytes look like and are caused by
A large cell membrane to volume ratio which causes the membrane to fold The cell looks like it has two areas of central pallor Usually due to improper filling of EDTA tubes (not enough blood) Has several variations, depending on the reference Considered an artefact of the areas of central pallor are all perpendicular to the feathered edge
32
Different types of leptocytes
They are often separated out and treated as separate cell types Codocyte Stomatocyte Knizocytes
33
Codocytes are
Also known as target cells Cells look like a bullseye or target The cells have a dense, central area of hemoglobin that is separated from the peripheral hemoglobin by a clear zone Up to 50% are normal in dogs - rarely seen on other species Can be due to artefact or underlying disease process
34
Stomatocytes are
Contain an oval central pallor Seen with hereditary stomatocytosis of Alaskan Malamutes Clinical significance is unknown
35
Knizocytes look like
Has a dark bar of hemoglobin across the center of the cell
36
Elliptocytes /ovalocytes look like and are normal in
Normal in camelids These are oval shaped red blood cells Abnormal in other species
37
Eccentrocytes look like
Believed to be the precursor to the keratocyte Loss of central pallor Have 1 or 2 large clear zones outlined by a membrane Often accompany heinz bodies Can be an artifact
38
Dacrocytes look like
Cells are shaped like a tera drop If all the tails of the dacrocytes are the same direction, they are likely an artefact
39
Ghost cells look like
These are cells that have been leached of their hemoglobin
40
Poikilocytes look like and is used when
This is a blanket term that means that the erythrocytes have an abnormal shape It should only be used when none of the other descriptors apply
41
Structures on or in RBCs
Basophilic stippling Howell-jolly bodies Heinz bodies Nucleated erythrocytes Siderotic granules Parasites
42
Basophilic stippling looks like
Looks like a blue dustin on the cell Caused by residual RNA
43
Howell-jolly bodies look like
Nuclear remnants These are small, round, dark- blue inclusions of variable size usually just off center Not to be confused with stain sediment
44
Heinz bodies look like
Oxidative denaturation of the hemoglobin 1-5% in normal cats Appear as small, eccentric ale structures within RBCs They appear to stick out or protrude from the edge In cats they are single and large In dogs they are small and multiple
45
Nucleated erythrocytes look like
The red blood cell will be slightly larger than a mature cell and will contain a nucleus Usually associated with an underlying pathology
46
How to Record nucleated RBCs
Count the number of nucleated RBCs (nRBC) seen while examining 100 WBCs for the differential count Recorded as nRBCs/100 WBCs Used to perform a corrected WbC count Corrected white blood count Corrected WBC count = (total WBC x 100)/ (100+ nRBCs)
47
Siderotic granules look like
Stainable iron granules within mitochondria and lysosomes (generally on the side of cells, lighter than Howell-Jolly bodies) Extremely rare
48
Parasites can look like
Often seen with agglutination and spherocytes due to immune mediated anaemia
49
Blood parasites found in domestic animal species include
Dirofilaria immitis Anaplasma Babesia Ehrlichia Mycoplasma
50
What are the most common parasites by species
Dogs are most commonly affected with dirofilaria immitis or babesia canvas Horses are most commonly affected with babesia caballi The most common blood parasite of cats is mycoplasma haemofelis
51
Dirofilaria immitis (heartworm) looks like
The immature stage circulates in the bloodstream and can be drawn into a syringe with a blood sample It will be a large worm on the slide and seen under low power
52
Mycoplasma haemofelis is
Cause feline hemotrop(h)ic mycoplasmosis (previously known as feline infectious anemia) due to lysis of the RBCs
53
How to tell the difference on a slide between Mycoplasma haemofelis and stain sediment
Can be difficult to differentiate from stain sediment of drying artefacts Stain sediment will be seen between the RBCs in equal proportions as on top of the RBCs Drying artefacts will be refractive and of varying shapes The microscope is only slightly refractive and goes in and out of focus when doing the red blood cells
54
Mycoplasma haemofelis looks like
They appear as small, oval to slightly rod shaped structures along the cells periphery as single organisms or in chains or rings (tiny strings of pearls) Agglutination is usually present as well Transmitted through blood- outdoor cats are more susceptible, particularly males Ectoparasites- most common Blood transfusions, fights- less common Possible from the queen to her kittens It may take several blood samples taken over the course of days/weeks to find the organism PCR test
55
Ehrlichia and anaplasma is in what animals
Various species of organisms affect cattle and dogs Transmitted by arthropods or ticks Significant name changes within this group of parasites has occurred in recent years
56
Ehrlichia and anaplasma looks like
Gram negative, rod shaped, spherical, coccoid, or ring shaped bodies within the RBCs Must be differentiated from Howell-Jolly bodies Blood smears made from the buffy coat may aid in diagnosis Diagnosis is usually confirmed with an ELISA snap test (immunological test) Has been found in Saskatoon in non-travelling dogs (previously only seen in US)
57
Babesia canis is infected by what
A protozoan infection Transmitted by ticks
58
Babesia canis looks like
Produces severe hemolytic anemia Usually appears as paired teardrop shaped organisms within the red blood cells The organisms stain darker than the rest of the red blood cell Babesia cabelli are very similar but are found in horses Babesia spp. affect cattle, goats, sheep, and cats
59
Viral inclusions in blood cells look like
Distemper inclusions are rarely seen in dogs When found, they appear as faint blue to magenta, round structures of variable size and number Usually seen in polychromatophilic red blood cells Can be seen in neutrophils as well
60
How many cells need to be examined to quantify abnormal morphology
Subjective Assessment–at least 200 cells should be examined (100x magnification in a non-anemic patient)
61
Quantifying rouleaux
1+ majority of cells are free, some chains of cells, maximum of 2-3 cells in a chain 2+ At least 1/2 of the cells are free, many chains of cells, usually <5 in a chain 3+ almost no free cells are present, most cells are in chains, >5 cells in a chain
62
Organization of a CBC
You should always perform tests in the same order It makes it less likely to miss a test component You can also separate tasks into categories to help minimize them from being missed Categories include: Direct measurements Microscopic procedures Calculations
63
Direct measurements are
PCV RBC count MCV WBC count Total protein Platelet count Mean platelet volume
64
Microscopic procedures are
Differential white blood cell count WBC estimation Toxic change RBC morphology Platelet morphology Platelet estimation Reticulocyte enumeration
65
Calculations for RBC
Absolute WBC count RBC indices MCV MCHC MCH Hemoglobin concentration
66
Reporting RBC morphology results
To report this data, one should organize by cell line or cell fragment Leukocytes Erythrocytes Platelets Keep each cell lien information together and always in the same order This will allow for a more efficient interpretation of results

Pathology theory (19 decks)

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