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122 Cards in this Set

  • Front
  • Back
What are the functions of RBCs?
transport O2 to tissues

synthesize hemoglobin (Hb)
Under what conditions is erythropoietin produced?
produced by kidney in response to hypoxia
What are the effects of erythropoietin?
↑ # of developing cells

↓ maturation time

↑ Hb synthesis w/in individual cells

↑ release of reticulocytes from BM
What is the functional abnormality of methemoglobin?
cannot carry O2 b/c iron is oxidized (Fe3+)
What is the comparative RBC lifespan in dogs, horses, cats, cows?
cat < dog < horse < cow
What does the PCV/Hct measure & which is more accurate?
% of whole blood that is RBCs

PCV considered more accurate
What factors can artifically increase measured Hb concentration?
lipemia, Heinz bodies, WBC > 50,000/µl, hyperbilirubinemia
What factors can cause errors in measured RBC count?
species RBC size variation, counting of large platelets, not counting small RBCs (microcytes), or agglutination
What is MCV?
mean corpuscular volume = average RBC volume (size)
What is MCHC?
mean corpuscular hemoglobin concentration = average conc. of Hb per RBC volume
What is RDW?
random distribution of RBC weight: distribution of RBC's based on their volume (size)
What does the plasma protein:fibrinogen ratio determine & in what species is it commonly measured?
used to determine cause of ↑ PP in LARGE ANIMALS

≥ 15 = dehydration
≤ 10 = inflammation
What is the name for an

a) increase
b) decrease

in MCV?
a. macrocytosis

b. microcytosis
What is the name for an

a) increase
b) decrease

in MCHC?
a. hyperchromasia

b. hypochromasia
What is the name for any abnormally shaped RBC?
poikilocyte
What is an acanthocyte & with what disorders is it associated?
spiculated RBC w/ single or multiple, irregular, blunt, rounded projections

liver dz (more in cats), microangiopathy, HSA
What is an keratocyte & with what disorders is it associated?
spiculated RBC w/ 1 or 2 pointed projections

Fe deficiency, liver disorders
What is an echinocyte & with what disorders is it associated?
spiculated RBC w/ numerous short, evenly shaped surface projections

snake bite envenomation, crenation, dehydration
What is an spherocyte & with what disorders is it associated?
small dense RBC lacking central pallor

IMHA, Heinz body anemia, transfusion
What is an schistocyte & with what disorders is it associated?
fragmented RBC

DIC, microangiopathy
What is an eccentrocyte & with what conditions is it associated?
RBC w/ condensed Hb in one area of cell

oxidative damage to Hb
What is a nucleated RBC & with what conditions is it associated?
Immature RBC w/ a nucleus in peripheral blood

intense BM stimulation, BM injury, after splenectomy, lead poisoning
What is a Howell Jolly body & with what conditions is it associated?
Basophilic nuclear remnants usually near edge of RBC (Romanowsky stains)

accelerated RBC production
What is a Heinz body & with what conditions is it associated?
Round structures (representing denatured Hb) on internal RBC membrane (NMB stain)

oxidative damage to Hb: onions, acetaminophen, Red Maple (horses), propofol (w/ repeated use), 1-2% clinically asymptomatic in cats
What is basophilic stippling & with what conditions is it associated?
RBCs containing residual RNA, appear as multiple, small blue dots w/ Romanowsky stains

ruminants: regeneration
other species: lead poisoning
What is agglutination & with what conditions is it associated?
Grape like aggregation of RBCs that will NOT disperse w/ saline dilution

IMHA
What is Rouleaux formation & with what conditions is it associated?
Grouping of RBCs resembling a stack of coins that disperses w/ saline dilution

- horse: normal
- cat, pig: slight amount normal
- other: chronic inflammation, multiple myeloma
What is crenation & with what conditions is it associated?
RBC w/ even distribution of sharp spikes (shape change occurs in all cells in given area)

artifact (old blood, delayed drying of blood film, improper anticoagulant ratio)
What are 4 parasites that may be found w/in RBCs?
Anaplasma
Babesia
Mycoplasma
Ehrlichia
What is polycythemia?
increase RBC count, PCV, Hb
What is relative polycythemia?
increased PCV, & Hb with normal total RBC mass
What are the 2 main causes of relative polycythemia?
dehydration: ↑ PP, dry skin & mucous mems, ↑ BUN, creatinine, USG (can calculate PP:fibrinogen ratio in LA)

splenic contraction: all parameters normal, may occur in horses & cats
What is absolute polycythemia?
increased PCV & Hb w/ ↑ in total RBC mass d/t ↑ erythropoiesis (less common than relative)
What is the cause of primary absolute polycythemia?
bone marrow disorder --> uncontrolled RBC production (RARE)
What are the 2 causes of secondary absolute polycythemia?
both cause increased EPO production

appropriate: d/t chronic hypoxia (CV dz, pulmonary dz, etc.)

inappropriate: : d/t renal dysfunction or neoplasia that produces ↑ EPO

can be iatrogenic: too much epogen
What is anemia?
↓ RBC count, PCV, & Hb
What 3 schemes are used to classify an anemia?
RBC indices (MCV, MCHC)
BM response (regenerative vs. non-regenerative)
underlying cause
What are the 3 main underlying causes of anemia, what are the associated changes in plasma protein, & how would you diagnosis each?
↓ RBC production
- PP NORMAL or ↑ (d/t inflammation)
- dx: reticulocytes, bone marrow

blood loss
-very early in acute blood loss, PCV will be NORMAL b/c both RBCs & plasma being lost at same proportion
-later, interstitial fluid moves rapidly into blood  ↓ PCV, ↓ PP
-dx: hx, lesions

↑ RBC destruction (lysis)
-may be intravascular or extravascular hemolysis
-PP NORMAL or ↑ (d/t inflammation)
-dx: icterus, RBC changes
What are some causes of microcytosis?
iron deficiency
PSS
normal in Akitas, Japanese Shiba

implies abnormal Hb synthesis --> smaller cells
What are some causes of macrocytosis?
regeneration
FeLV
may be normal in Poodles
false (d/t agglutination)

assoc. w/ increased erythropoeisis --> release of retics (larger than mature RBCs)
What are some causes of hypochromasia?
Fe deficiency
reticulocytosis
What are some causes of hyperchromasia?
hemolysis (true hyperchromic cells don’t exist)
What is the most common type of anemia based on RBC indices?

Is it usually regenerative or non-regenerative?
normocytic normochromic

usually non-regenerative
ddx for microcytic hypochromic anemia

Is it usually regenerative or non-regenerative?
Fe deficiency (most common), PSS, anemia of chronic dz, etc.

poorly or non- regenerative
ddx for macrocytic hypochromic anemia
regenerative anemia (reticulocytosis)
ddx for macrocytic normochromic anemia
FeLV (altered RBC maturation), may be normal in miniature & toy poodles
What signs are evidence of regeneration on a blood smear?
reticulocytosis
basophilic stippling (bovine)
macrocytosis (horse)
Howell Jolly bodies
anisocytosis
What are the unique factors assoc. w/ regeneration in

a. horses
b. cows
c. cats
a. no reticulocytosis, look for macrocytosis, look in bone marrow

b. inconsistent release of retics; look for basophilic stippling

c. 2 types of retics
-aggregate: similar to dog retics (indicates a recent stimulus (a few days))
-punctate: cells contain dots & not aggregated RNA (indicates a stimulus 1-3 weeks previously)
What are the 2 major causes of regenerative anemia?
blood loss

hemolysis
What are the early pre-regenerative responses during acute blood loss?
↑ blood volume: shift ECF to IV space

↑ RBCs: splenic contraction
What other hemogram or chemistry abnormalities are associated w/ blood loss anemia?
decreased plasma protein
What other hemogram or chemistry abnormalities are associated w/ hemolytic anemia?
normal or ↑ PP hyperbilirubinemia hemoglobinemia
hemoglobinuria
RBC morphology (spherocytes, parasites, Heinz bodies)
What is extravascular hemolysis & what is a commonly associated serum chemistry change?
abnormal RBCs phagocytosed by MPS in spleen & liver (more common)

hyperbilirubinemia usually present
What are some causes of extravascular hemolysis?
IMHA, oxidative damage, intrinsic RBC defects, parasites
What RBC morphologic changes are associated w/ IMHA?
anisocytosis, polychromasia (regeneration), agglutination, spherocytes, ghost cells, ↑ MCV (d/t retics & agglutination)
What is the Coomb's test?
used to help dx IMHA

detects Ab &/or complement bound to patient’s RBCs

positive ≠ 1º IMHA
What RBC morphologic changes are associated w/ oxidative hemolytic anemia?
Heinz bodies, eccentrocytes

methemoglobinemia

also called Heinz body hemolytic anemia
What are the features assoc. w/ pyruvate kinase deficiency?
PK needed for ATP production (needed to maintain RBC mems)

consistent hemolysis, severe anemia w/ marked regeneration

survival < 3-5 yrs

congenital in Beagles, Basenjis
What are the features assoc. w/ phosphofructokinase deficiency?
PFK needed for ATP production (needed to maintain RBC mems)

hemolysis induced by alkalosis (ex. stress, exercise-induced hyperventilation)

English Spring Spaniels
What is intravascular hemolysis & what are 2 prominent features that help to dx it?
RBCs lysed w/in bloodstream: poorer px

hemoglobinemia, hemoglobinuria
What are some causes of intravascular hemolysis?
complement mediated, bacterial toxins, parasites, hereditary, chemicals/toxins
What are some causes of fragmentation of RBCs (subset of intravascular hemolysis)?
microangiopathy: abnormal small vessels (see acanthocytes, schistocytes)
ex. HSA, vasculitis

DIC: fibrin deposited in vessels (schistocytes)
What CBC findings are consistent w/ nonregenerative anemia?
no retics
no polychromasia
variable anisocytosis
N to ↑ nRBCs
N to variable MCV & MCHC
hx: chronic
What is the main defect associated w/ non-regenerative anemias?
decreased erythropoiesis = hypoproliferative BM d/t inadequate # of precursors or inadequate stimulus
What are some causes of non-regenerative anemia?
Fe deficiency
ACD
lack of EPO
BM damage
myelophthisis
What are some causes of iron deficiency anemia?
chronic blood loss: parasites, ulcers (most common)

dietary deficiency: young animals (uncommon)

malabsorption: intestinal dz
What lab findings are consistent w/ iron deficiency anemia?
microcytic hypochromic anemia

non-regenerative

↓ serum iron

↓ bone marrow iron stores

↓ ferritin (storage form of iron)

thrombocytosis: megakaryocytes respond to EPO
What is the most common anemia of domestic animals?
anemia of chronic dz
What lab findings are consistent w/ anemia of chronic dz?
initially, normocytic, normochromic

over a long time, can progress to microcytic, hypochromic

non-regenerative

↓ serum iron: iron sequestered in MPs

normal ferritin

thrombocytosis: d/t inflammatory mediators
How could you differentiate non-regenerative anemia as being caused by Fe defeciency or ACD?
give patient some iron
improvement = Fe deficiency
no improvement = ACD
What are some examples of multifactoral anemias?
neoplasia
chronic renal failure
endocrine disorders: hyperestrogenism (ferrets, dogs), hypothyroidism, Addison's
FelV
What is aplastic anemia & what are some causes?
depletion of all 3 cell lines in blood & BM

causes: estrogen, infections (Ehrlichia, FelV), drugs, plants, radiation
What are 3 main underlying causes of thrombocytopenia?
increased destruction (common)

increased consumption or sequestration

decreased production
What are the functions of platelets?
plug endothelial lesions, clot formation, release soluble mediators
How do platelets form & what controls their production?
produced by “flaking off” from megakaryocytes

thrombopoietin controls production
What are common causes of thrombocytopenia d/t increased destruction?
immune mediated
1º (autoimmune): Abs against self Ag on megakaryocytes &/or platelets
2º: Abs against non-self Ag on platelet surface
What are common causes of thrombocytopenia d/t increased consumption or sequestration?
DIC: most common

sequestration (ex. spleen): transient, not common

massive hemorrhage: would take huge blood loss
What are common causes of thrombocytopenia d/t decreased production?
marrow suppression d/t drugs, toxins, infectious agents, neoplasia, etc.

↓ platelets w/ ↓ WBCs &/or ↓ RBCs
What are some characteristics of platelet regeneration?
large platelets

↑ MPV

BM: megakaryocytic hyperplasia (↑ # of megakaryocytes)
What are 3 main categories of thrombocytosis?
physiologic: common
reactive: common
myeloproliferative/neoplastic: rare
What are causes of physiologic thrombocytosis?
transient mobilization: minutes to hours (d/t splenic contraction)

exercise & epinephrine
What are causes of reactive thrombocytosis?
↑ production by BM d/t:
thrombopoietin
erythropoietin (anemia)
inflammation
What is Evans' syndrome?
concurrent IMHA & IMTP
In what species are lymphocytes usually more prevalent in peripheral blood than neutrophils?
cattle
What is meant by the term left shift?
indicates presence of immature granulocytes (usually neutrophils) in blood
What is a regenerative left shift?
leukocytosis in which mature neutrophils outnumber immature neutrophils
What is a degenerative left shift?
immature neutrophils outnumber mature neutrophils

indicates excessive demand &/or inadequate supply (more guarded px)
What is a leukemoid rxn?
very high neutrophil count w/ a severe, but orderly left shift

indicates severe inflammation but a responding bone marrow
What are the CBC changes consistent w/ leukemia?
presence of neoplastic hematopoietic cells in circulation

leukocytosis; immature forms: often 1 stage overrepresented; disorderly maturation
What are the functions of neutrophils?
chemotaxis: cell migration to site of inflammation

engulfment/killing: release of granule contents (enzymes that kill bacteria)
What are band neutrophils?
immature neutrophils that has a nucleus w/ parallel sides
What are hypersegmented neutrophils?
neutrophils w/ 5 or more distinct nuclear lobes

indication of prolonged transit time (glucocorticoids)
What are toxic neutrophils & what 3 morphologic features do they possess?
indicate inflammation (↑ demand for neutrophils)

↑ basophilia of cytoplasm, vacuolated (foamy) cytoplasm, Dohle bodies (bluish angular cytoplasmic inclusions
What are the 3 neutrophil pools found in the bone marrow?
proliferating pool: contains BM cells capable of division
-time from myeloblast --> metamyelocyte: ~2.5 days

maturation pool: contains BM cells NOT capable of division
-transit time: ~2.5 days

storage pool: contains mature BM cells (subset of maturation pool)
-constitutes body’s reserve of neutrophils
-usually have ~5 day supply in BM storage
-wimpy in cattle
What are the 2 neutrophil pools found in blood?
marginated pool: neutrophils that have marginated along blood vessel walls
-same size as circulating pool in dogs, horses, calves
-3x larger than circulating pool in cats

circulating pool: neutrophils in larger blood vessels moving in the main stream of blood
-pool that’s sampled when taking a blood sample for CBC
What is the comparative order of species in terms of intensity of immune response to inflammation: cats, dogs, horses, cows?
dog > cat > horse > cow
What WBC characteristics are consistent w/ inflammation w/ a mild to moderate tissue demand (ex. abscess?)
neutrophilia +/- left shift, monocytosis, toxic neutrophils may be seen
What WBC characteristics are consistent w/ inflammation w/ continued tussue demand (ex. pyometra?)
neutrophilia w/ regenerative left shift & toxic neutrophils, monocytosis
What WBC characteristics are consistent w/ inflammation w/ an excessive tissue demand (ex. Salmonellosis?)
neutropenia, degenerative left shift, toxic neutrophils

insufficient storage cells for demand & BM has not had time to respond
What WBC changes are expected in cattle w/

a. subacute or chronic inflammation?
b. inflammation w/ moderate tissue demand?
a. neutrophilia, esp. w/ a left shift

b. normal neutrophil count or neutropenia, left shift, & toxic neutrophils
What are some causes of neutropenia?
sequestration

increased margination (ex. endotoxins: lasts 1-3 hrs)

decreased production: BM usually reveals myeloid hypoplasia (caused by damage to myeloid precursors): FeLV, feline panleuk, Ehrlichia, toxicities, drugs, neoplasia

ineffective production, increased destruction: rare
What is leukocyte adhesion deficiency?
WBCs can’t migrate from circulation --> neutrophilic leukocytosis
What is Pelger-Huet Anomaly?
hyposegmented nuclei of neutrophils, eosinophils, basophils

normal function

concern is not to mistake for a left shift inflammatory process
What is Chediak-Higashi syndrome?
large granules in neutrophils, eosinophils, basophils

defective microbiocidal activity

defective platelets --> ↑ bleeding times
What is cyclic neutropenia of Collies?
stem cell defect --> cyclic myelopoiesis every 11 days
What diseases are assoc. w/ acquired functional abnormalities of neutrophils?
diabetes mellitus (if poorly controlled)
vaccines
zinc deficiency (dogs)
selenium deficiency (cattle)
drugs (steroids, NSAIDs, some ABs)
What is physiologic leukocytosis (epinephrine response)?
causes by epi (fear, excitement) or sudden strenuous exercise

response time almost immediate, but is short-lived (~30 minutes)
key features: mature neutrophilia, lymphocytosis

most pronounced in cats, horses

dogs: usually mild neutrophilia only
What is corticosteroid induced leukocytosis (stress response)?
caused by either endogenous or exogenous steroids

response takes several hours to develop w/ peak rxns in 4-8 hrs

key features: mature neutrophilia, lymphopenia, eosinopenia, monocytosis (not a consistent finding, even in dogs)

dogs have most classic response

lymphopenia is most consistent & occasionally the only finding
What are some causes of lymphocytosis?
epinephrine response
immunological stimulation
infectious dz: Ehrlichia, bovine leukemia virus
lymphocytic leukemia
Addison's: stressed dog lacking a stress response
normal in cows, swine
What are some causes of lymphopenia?
stress response
acute infections (esp. viral)
loss of lymph
radiation/chemo
immunodeficiency (less common)
What are the functions of monocytes?
phagocytosis & degradation of ingested material

present antigen to initiate lymphocyte responses
What are some causes of monocytosis?
think CHRONIC INFLAMMATION 1st!: tissue destruction, necrosis, intracellular or fungal organisms

stress response: esp. in dogs

immune mediated disorders
What are the functions of eosinophils?
regulation of type I (immediate) & type III (delayed) hypersensitivity rxns

antiparasitic properties

bacterial phagocytosis (less so than neutrophils)

activation of plasminogen
What are some causes of eosinophilia?
parasites
hypersensitivity rxns
hypereosinophilic syndromes
neoplasia
What are the functions of basophils?
hypersensitivity (histamine release)

follow eosinophils

possible cytotoxic effects
against tumor cells

possibly anti-parasitic
What are some causes of basophilia?
w/ eosinophilia: parasites, hypersensitivity, neoplasia

rare to have w/o eosinophilia: basophilic leukemia
What is leukemia?
neoplastic cells of BM origin in circulation --> leukocytosis
What is lymphoma?
neoplasm of lymphocytes arising as a solid tissue mass in organs other than BM (ex. lymph node, liver, spleen, GI, etc.)

MUCH MORE COMMON THAN LEUKEMIA
What is myeloproliferative dz?
proliferation of granulocytic, megakaryocytic, erythrocytic, &/or stromal CT cells in BM
What are myelodysplastic syndromes?
ineffective hematopoiesis w/ resultant peripheral blood cytopenias (ex. FeLV)
What are some causes of mastocytosis?
malignant disseminated mast cell neoplasm

immediate type hypersensitivity rxn
How is leukemia classified?
based on natural duration of dz
-acute: very little differentiation of neoplastic cells (mostly blasts); duration of illness is short; poor px
-chronic: well-differentiated neoplastic cells; may live for months or years after dx

based on cytology
-myeloproliferative: neoplastic proliferation of non-lymphoid cells (ex. neutrophils, eosinophils, basophils, monocytes, RBCs, megakaryocytes)
-lymphoproliferative: neoplastic proliferation of lymphocytes