WBC 2: Inflammation

Question 1

Inflammatory leukocytosis

Answer 1

When there is an increased demand for inflammatory cells

Question 2

What is the bone marrows response to inflammatory leukocytosis?

Answer 2

-release mature neutrophils from storage pool
-release of immature neutrophils (left shift)
-increased speed of production (toxic change)

Question 3

What is common on a classic inflammatory leukogram?

Answer 3

-increased neutrophils (mild to marked)
-increased bands (left shift)
-potential presence of toxic change
-metamyelocytes, myelocytes
-monocytes will be normal or increased
-potential presence of thrombocytosis

Question 4

What is a left shift?

Answer 4

Shift toward immaturity
-results when there is early release of neutrophil precursors from bone marrow (bands and sometimes metamyelocytes)

Question 5

Grading left shifts

Answer 5

Question 6

What are Degenerative left shifts?

Answer 6

When immature neutrophils are equal to or greater in number than mature neutrophils
*mature neutrophils are normal or decreased

Question 7

What does a degenerative left shift tell you?

Answer 7

That the bone marrow is not meeting the tissue demand for neutrophils
*animal is often in poor clinical condition

Question 8

What is toxic change?

Answer 8

Abnormally rapid maturation in bone marrow
*see foamy cytoplasm, basophilic cytoplasm, dohle bodies, toxic granulation

Question 9

How is toxic change graded?

Answer 9

By severity 1+ (mild) to 4+ (severe)

Question 10

How is inflammation classified?

Answer 10

-by pattern of inflammation changes
-often linked with certain time frame

Question 11

What are the 4 types of inflammatory patterns?

Answer 11

1. peracute to acure, severe inflammation
2. Acute inflammation
3. Chronic/established inflammation
4. combined patterns

Question 12

Peracute to acute severe inflammation pattern

Answer 12

Peracute=1-3hrs, acute=6-8hrs
*often not seen by vet; early on

-Neutropenia- because they are migrating into tissues
*transient

-left shift and/or toxic change possible

Question 13

Differences with Cattle with neutropenia

Answer 13

They have little bone marrow reserve therefore have a low marrow responsiveness
-neutropenia persists for days AND does not indicate poor prognosis

Question 14

Acute inflammation pattern

Answer 14

-usually over acute duration BUT NOT ALWAYS

-neutrophils normal or increased
-active need for neutrophils at site of inflammation= left shift
-potential for toxic change and/or monocytosis

Question 15

Chronic/established inflammation pattern

Answer 15

Granulocytic hyperplasia in bone marrow takes time (days to weeks) and in chronic cases, bone marrow has chance to reach new steady state!

SIgns:
-neutrophilia (often marked)
-very mild left shift
-no toxic change
-potential for monocytosis

Question 16

Combined patterns

Answer 16

1. Inflammation and stress
2. Acute on chronic inflammation

Question 17

Inflammation and stress combined patterns

Answer 17

-neutrophilia and left shift
-lymphopenia

Question 18

Acute on chronic inflammation combined pattern

Answer 18

-moderate to marked neutrophilia (+/- marked monocytosis)

-moderate left shift (+/- toxic change)

Question 19

What is considered Extreme neutrophilia?

Answer 19

> 50 x 10^9 neutrophils/L in dogs

**leukemoid response!

Question 20

What causes extreme neutrophilia?

Answer 20

Focal suppurative lesions
-peritonitis, pyothorax, pyometra, prostatitis, pneumonia, abscesses
-secondary to IMHA or neoplasia

Question 21

What is a differential diagnosis for extreme neutrophilia?

Answer 21

Neutrophilic leukemia

Question 22

Serial leukograms

Answer 22

Recommended in establishing trends to determine prognosis

Question 23

What indicates a good prognosis?

Answer 23

-increase in neutrophil numbers
-decrease in left shift (fewer bands)
-resolution of toxic change
-resolution of lymphopenia