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clinical pathology > RBCs > Flashcards

RBCs Flashcards

1
Q

basophilic stippling

A

aggregates of ribosomes that are visualized as small basophilic granules within an RBC

most often seen in immature erythrocytes of ruminants

also seen in immature erthyrocytes of dogs and cats with highly regenerative anemias

lead poisoning

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2
Q

hemoglobin functions

A

transport O2 from lungs to tissues

transport CO2 from tissues to lungs

buffer hydrogen

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3
Q

Hgb physiology

A

iron in Hgb molecule must be in the reduced form to bind oxygen

when oxidized-called methemoglobin

too much methemoglobin-mucous membranes cyanotic and blood is brown

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4
Q

iron metabolism

A

absorbed from intestine-small % in health, during disease increased

transported in blood by transferrin

stored in tissues as hemosiderin or in plasma bound to ferritin

evaluation of iron content of body: serum iron, serum total iron-binding capacity, serum ferritin or bone marrow hemosiderin content

serum iron is low in iron deficiency but also low in conditions where tissue iron is normal or increased

serum ferritin best serum indicator of total body iron content

TIBC-measure of transferrin in blood

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5
Q

Erythrocyte lifespan

A

dog-120 days

cat-70 days

cow-160 days

horse-145 days

relatively long lived compared to other blood cells

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6
Q

destruction of RBCs

A

removed by macrophages which attached to RBC membrane

RBC lysed and hemoglobin degraded into heme and globin

Globin–>amino acids

Heme–>iron and bilirubin

bilirubin-released from macrophages into circulation where albumin binds it and transports it to the liver where it is conjugated and excreted in the bile

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7
Q

microcytic RBCs

A

iron deficiency anemia (chronic blood loss)-related to extra cell division as RBCs mature in marrow

Portosystemic shunts/liver failure-altered iron kinetics

specific breeds-akita, shiba dogs

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8
Q

macrocytic

A

significantly increased number of young RBCs in circulation

FeLV (no poly)

poodle macrocytosis (rare)

hereditary stomatocytosis

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9
Q

anisocytosis

A

variation in RBC size

RDW

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10
Q

hypochromic RBCs

A

associated with significantly increased numbers of reticulocytes in circulation

iron deficiency-Hgb synthesis is impaired

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11
Q

hyperchromic RBCs

A

almost always an artifact

can’t produce RBCs with too much Hgb

may be free Hgb in plasma (hemoglobinemia) or presence of interfering substances or structures (lipemia, icterus, Heinz bodies)

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12
Q

normal shape for dog

A

biconcave disk with central pallor

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13
Q

normal shape for cat, pig, horse, cow, sheep

A

discoid shape with little to no central pallor

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14
Q

normal shape for Llama, camle, bird, reptile

A

ellitical shape

bird & reptile-nucleated RBCs

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15
Q

poikilocyte

A

abnormall shapred RBC

may be present in healthy goats, pigs and young cattle

frequently seen in dogs and ruminants with iron deficiency

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16
Q

spherocyte

A

decreased diameter, decreased ccentral pallor, increased staining intensity

typically have relatively normal cell volumes

suggest immune mediated damage to RBCs

form from partial phagocytosis of RBC membranes by macrophages

associated with blood transfusion, bee sting and zinc toxicity

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17
Q

schistocyte

A

irregulatly shaped RBC fragment that occurs when RBCs are forced through altered vascular channels, vessels containing fibrin strands or exposed to turublent blood flow

associated wtih DIC, Hemangiosarcoma, vasculitis and +/- iron deficiency

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18
Q

keratocyte

A

RBC with blister or 2 “hornlike” projections

formed by intravascular trauma or iron deficiency

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19
Q

eccentrocyte

A

RBC with Hgb shifted to one side and a clear membrane bound area on the opposite side

form from oxidative damage to RBC membranes

may be seen with Heinz bodies

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20
Q

ghost cell

A

formed from lysis of RBCs

very pale staining cells consisting of an empty RBC membrane

artifactual or pathologic (IMHA, Heniz body hemolysis)

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21
Q

acanthocyte

A

RBC with irregularly spaced surface projections of variable length and diameter

result of altered lipid/cholesterol content of cellular membranes

associated wtih splenic hemangiosarcoma, liver disease, renal disease

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22
Q

Echinocyte

A

RBC with many short evenly spaced uniform surface projection

artifact-associated with blood film prep and slow drying

pathologic- eletrolyte depletion, renal disease, neoplasia, rattlesnake envenomation, chemotherapy

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23
Q

Codocyte

A

RBC that has excess membrane

“target cell”

central area of Hgb surrounded by clear ring and an outer rim of Hgb

associated with regenerative anemia in dogs, hepatic and renal dz

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24
Q

Heinz bodies

A

clumps of denatured Hgb that results from oxidative damage

Wright: appear small eccentric pale structures that often protrube from the cell margin

NMB: dense blue structures

RBCs more susceptible to intravascular and extravascular hemolysis

up to 10% normal in cats

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25
Q

Howell-Jolly bodies

A

nuclear fragments retained within an RBC

appear small round dark blue inclusions

increased numbres may be seen in regenerative anemias, splenectomy or suppressed splenic function

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26
Q

Siderotic granules (pappenheimer bodies)

A

iron granules within mitochondria and lysosomes

impaired Heme synthesis, myelodysplasia and ineffective erythropoiesis

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27
Q

nucleated erythrocytes

A

metarubricytes (metarubricytosis)

never normal to see

present due to toxic, hypoxic or physical damage to bone marrow endothelium

associated with regenerative anemia

should not be used as an indicator of RBC regeneration

other r/o: lead poisoning, chemotherapeutic use, neoplasia or inflammation with marrow space and splenic contraction or dysfunction

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28
Q

Rouleaux

A

spontaenous association of RBCs in linera stacks

normal in horses

slight amount in cats and some dogs

enhanced with increased plasma proteins

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29
Q

Agglutination

A

irregular spherical clumps of RBC

grape like clusters

caused by antibody bridging between RBCs

DDx: IMHA

30
Q

How to differentiate rouleaux from agglunation

A

small amount of blood and saline are mixed together

rouleaux will disperse

agglutination will stay the same

31
Q

anemia

A

not a disease

determine underlying cause

decrease in HCT, [Hgb] or RBC count

32
Q

bone marrow response to anemia

A

decreased circulating RBCs–>hypoxmia

Epo producing cells in renal cortex sense hypoxmia–>increased production of Epo

increase in Epo stimulates bone marrow to increase RBC production

33
Q

when do reticulocytes appear in blood

A

within 2-3 days

peak within 7 to 10 d

34
Q

Reticulocytes

A

show up as RBCs with large blue mats of RNA and mitochondria when stained with New Methylene Blue stain

35
Q

polychromasia

A

larger, pink/blue RBCs viewed on a Wright stained blood smear

+1 poly can be normal in dog

36
Q

reticulocyte count

A

indicative of regenerative anemia

assessment of bone marrow response

37
Q

horses and reticulocytes

A

they do not release reticulocytes into the peripheral circulation

do serial CBCs or bone marrow biopsy

38
Q

Patient history with anemia

A

duration of clinical signs (acute vs chronic), exposure to drugs, plants, chemicals, history of blood loss (hematuria, melena, epistaxis), parasite control, etc

39
Q

physical exam of patient with anemia

A

icterus, bruisng, petechial or ecchymotic hemorrhages, cyanosis, mucus membrane color, hydration status, evidence of trauma, abdominal distention, etc

40
Q

acute hemorrhage

A

HCT and plasma proteins concentration will not decrease until the plasma volume is replaced

over the next 24 to 72 hours, fluid moves into circulation to re-establish blood loss

HCT and plasma protein concentration will decrease

internal or external

41
Q

What is anemia of blood loss initiated characterized as?

A

normocytic, normochromic non-regenerative anemia

42
Q

What can anemia of blood loss become?

A

macrocytic, hypochromic regenerative anemia

increased number of reticulocytes

43
Q

causes of blood loss

A

trauma

coagulopathies

surgical procedures

parasites

neoplasia

44
Q

causes of iron deficiency anemia

A

mature animals: result of chronic blood loss

neonates: poor iron intake and high growth rates

45
Q

typical cbc findings for iron deficiency anemia

A

microcytic, normochromic or microcytic, hypochromic

regenerative but in later stages show poor signs of regeneration

hypoproteinemia

Keratocytes, schistocytes, hypochromic RBCs

Low serum ferritin and poor iron stores in bone marrow

thrombocytosis

46
Q

clinical intravascular hemolysis

A

within blood vessels or heart

marked RBC damage

marked or rapidly falling anemia

occurs hours to days after insult

reticulocytosis occurs are presentation

Hemoglobinemia

Hemoglobinuria

+/- Hyperbilirubinemia

+/-bilirubinuria

47
Q

predominantly extravascular hemolysis

A

macrophages of spleen, liver and bone marrow

mild to marked RBC damage

mild to marked anemia

occurs over days to weeks

reticulocytosis at initial presentation

hyperbilirubinemia

bilirubinuria

48
Q

haptoglobin

A

in circulation

binds free Hgb

taken up by hepatocytes when bound to Hgb

causes pink to red color in plasma

49
Q

Immune mediated hemolytic anemia

A

typically regenerative

normocytic, normochromic or macrocytic, hypochromic

spherocytes

Positive Coombs’ test

agglutination

inflammatory leukogram

+/-hemoglobinemia/hemoglobinuria

50
Q

Mycoplasma haemofelis

A

small blue rod or ring forms on the surface of RBCs

spread through infected blood via blood feeding arthropods

also spread from queen to kittens

51
Q

mycoplasma haemocanis

A

small chains of cocci that may branch

usually only causes disase in immunosuppressed dogs or splenectomized animals

52
Q

Mycoplasma wenyonii (cattle)

Mycoplasmas ovis (sheep, goats)

Mycoplasma haemolamae (llamas, alpacas)

A

small basophilic structures on RBCs or sometimes free in the background

53
Q

Anaplasmosis

A

Rickettsial organism

larger than Mycoplasma but smaller than Howell Jolly bodies

usually around basophilic structures

transmitted by ticks, biting flies and iatrogenically

hemolytic anemia in cattle sheep and goats

54
Q

Babesiosis

A

Causes hemolytic anemia

Babesia canis & B. gibsoni (dog)

B. equi (horse)

B. bigemina (ruminants)

piriform

transmitted by tick, direct blood contamination

55
Q

Theileriosis

A
56
Q

Cytauxzoonosis

A
57
Q

Feline Heinz body anemia DDx

A

acetaminophen

onion/garlic

propylene glycol

zinc toxicity

methylene blue

propofol

DM

Hepatic lipidosis

hyperthyroidism

hymphosacroma

58
Q

canine heinz body anemia DDx

A

onion/garlic

acetaminophen

zinc toxicity

propylene glycol

propofol

benzocaine

naphthalene

59
Q

Equine heinz body anemia DDx

A

red maple leaf ingestion

onion/garlic

60
Q

ruminant heinz body anemia DDx

A

Brassica sp (kale, rape, cabbage)

onion/garlic

copper toxicosis

selenium deficiency

61
Q

Fragmentation Anemia

A

results from direct physical trauma to RBCs caused by DIC, vasculitis, vascular tumors, etc

increased schistocytes and keratocytes

62
Q

DDx for nonregenerative anemia

A

Anemia of inflammation (chronic disease)

Anemia of chronic renal failure

pure red cell aplasia

aplastic pancytopenia

bone marrow replacement

63
Q

Anemia of Inflammation

Anemia of chronic disease

A

common

mild to moderate anemia

develops over days to weeks then stabilizes

resolves with correction of underlying cause

normocytic, normochromic non-regenerative

64
Q

Anemia of inflammation pathophysiology

A

complex and multifactorial

altered iron kinetics

decreased EPO production

decreased marrow response to Epo

decreased RBC life span

65
Q

Anemia of CKD

A

moderate to severe

normocytic, normochromic non-regenerative

result of decreased Epo production

correlates wtih severity of CKD

66
Q

Pure red cell aplasia

A

severe normocytic, normochromic non-regenerative anemia

normal leukocyte and platelet numbers

marked decrease in erythroid precursors in bone marrow with normal granulocytic precursors and megakaryocytes

caused by immune mediated destruction of erythroid precursors in bone marrow

occ. spherocytes

direct Coombs’ test infrequently positive

67
Q

Aplastic pancytopenia

A

biocytopenia

bone marrow space is replaced by fat

normocytic, normochromic non-regenerative anemia

caused by reversible or irreversible damage to hematopoietic precursors in bone marrow

drugs, toxins, estrogen, infectious agents (parvovirus, FeLV, Ehrlichia canis)

68
Q

bone marrow replacement

A

one or more cytopenia

neoplasia & myelofibrosis

69
Q

Erythrocytosis

A

aka polycythemia

increased concentration of RBCs in circulation

increased HCT, RBC count and [Hgb]

70
Q

Relative erythrocytosis

A

loss of body fluid

splenic conctraction (epinephrine leukogram)

71
Q

absolute erythrocytosis

A

primary-polycythemia vera-rare chronic myeloproliferative disorder

secondary appropriate-systemic hypoxemia due to lung dz, cardiac dz or high altitudes; results in increased Epo production

secondary inapproriate-renal ischemia or erythropoietin producing tumor

72
Q
A

clinical pathology (8 decks)

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