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110 Cards in this Set
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confound for hemoglobin content
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high WBC
lipemia RBC agglutination Heinz bodies Sample lysis |
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MCV
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mean corpuscular/cell volume
average RBC size |
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MCHC
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mean cellular hemoglobin concentration
average Hb/RBC mass (g/dL) |
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MCH
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mean cellular hemoglobin
avg Hb/RBC (pg) |
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hyperchromic RBC
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high MCHC
d/t artifact: false inc in Hb |
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RWD
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red cell distribution width (%)
overall variation in cell size |
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MPV
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mean platelet volume
avg size of platelets |
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PDW
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platelet distribution width
overall variation in platelet size |
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CBC/blood smear evaluation
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WBC: differential, morphology
RBC: morphology (gross anemia) Pl: clumping, est #, morphology |
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reticulocyte
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immature RBCs in circulation
signifies regenerative anemia count via new methylene blue stain (# retics/100 RBCs) |
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cat reticulocytes
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1. aggregate retics-large clumps
2. punctate retics-small dots |
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best sample collection
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fasted
largest vein possible avoid small needle avoid IV catheter/heparin coated clean stick |
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purple top tube
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EDTA-anticoagulant
dont under or over-fill |
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red top tube
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serum clot tube-lets blood clot
glass only for cytology |
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tiger top tube
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serum separater tube
dont use for cytology |
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blue top/sodium citrate tube
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anticoagulant for coagulation testing
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green top/heparin tube
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chemistry, blood gas, exotic hematologies
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Romanowski type stains
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diff-quik, wright-geimsa etc
good nuclear & cytoplasmic detail RBCs are pink |
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Kohler illumination technique
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1. focus on slide @ 10x
2. close field diaphragm (bottom) 3. adjust condenser (under stage) until diaphragm is in sharp focus 4. center light 5. open field diaphragm (bottom) to flood w/ light 6. open condenser diaphragm |
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Systematic smear evaluation
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1. feathered edge @ low power
2. est Hct and WBC counts-10x 3. Find monolayer 4. WBC diff/morph @ 40x 5. RBC morph+/-inclusions @ 100x 6. platelet est/morph @ 100x |
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estimation of WBC density
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@ 10x on feathered edge
count 5-10 fields, avg and x330 |
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RBC morph components
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1. ansiocytosis
2. polychromasia 3. poikilocytosis 4. type of poikilocytosis + give grade (slight-marked OR rare-marked) |
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platelet estimate
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5-10 100x fields in monolayer and average, x 2000 = pl/uL
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effects of increased erythropoietin
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-inc proliferation
-dec maturation time -inc Hb synth -early Retic release |
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methemoglobin
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oxidized Fe that cant bind O2
dark brown blood |
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carboxyhemoglobin
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Hb bound to CO, cant bind O2
cherry red blood (even venous) |
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Heme synthesis requires
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1. IRON
2. copper 3. Vit B6 |
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Causes of Fe deficiency
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1. nutritional (esp young)
2. chronic blood loss 3. inflammatory reason to not use iron |
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Sign of Fe deficiency
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microcytic hypochromia
(extra divisions of RBCs to get small enough for Hb% to be correct, then low Hb) |
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RBC nuclear maturation requires
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1. Vit B12 (cobalamin)
2. folic acid 3. riboflavin (defic via malabs, GI/panc dz) |
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reduced glutathione fxn
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prevents oxidative damage to hemoglobin
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ATP fxn in RBC
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1. cell deformity
2. cell shape (Na+/K+ pump) 3. maintain membrane |
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2,3 DPG
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high 2,3 DPG= low O2 affinity for Hb
inc in anemia (at energy expense) |
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RBC lifespan
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faster turnover in small animals = inc retic % in circulation
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RBC destruction
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1.Macs in spleen phagocytose
2. Fe/globin recycled 3. Heme metab-->bilirubin 4. LVR conjugates bilirubin --> c-bilirubin 5. secretes to gall bladder 6. urobilinogen rel to intestine |
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anisocytosis
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variation in cell SIZE
RDW is a measure of anisocytosis |
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macrocytic
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larger RBCs vs normal are present
increased MCV |
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microcytic
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smaller RBCs vs normal are present
decreased MCV |
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polychromatophilia
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regenerative response to anemia
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polychromatophil-photo
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polychromatophil
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hypochromic
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pale staining RBC
increased central pallor less Hb low MCHC |
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Microcyte ddx
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1. Fe deficiency
2. portosystemic shunt 3. normal variant in asian dog breeds (healthy) 4. RARE: anemia of inflammatory dz |
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Macrocyte ddx
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1. immature RBC/retic
2. breed issues (poodles) 3. cattle w/ low cobalt and high molybdenum 4. dysplastic BM change (us. nonregen anemia) |
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hypochromia-photo
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hypochromia
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causes of hypochromia
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1. Fe deficiency
2. anemia of chronic dz |
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punched out RBC-photo
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punched out RBC
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spherocyte-photo
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spherocyte
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Spherocytosis ddx
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1. IMHA
2. transfusion 3. Heinz body HA 4. Zn toxicity |
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polychromatophil
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RBC w/ blue tinge, usually larger than normal
NMB staining would show reticulocyte % retic>%polychromatophils |
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punched out RBC
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artifact
well demarcated increased central pallor Hb rim normal color |
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Spherocyte
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small round cell with no central pallor
loss of membrane -d/t mac removal of Ab or Heinz body -Hg content normal |
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schistocyte-photo
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schistocyte
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schistocyte
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RBC fragment d/t trauma/shearing
DDx: 1. DIC 2. Hemangiosarc 3. endocarditis 4. Fe deficiency (fragile) 5. Thrombi |
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acanthocyte-photo
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acanthocyte
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acanthocyte
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spiculated RBC with single or >1 irregular projections
may be long w/ rounded end DDx: 1. feline hepatic lipidosis 2. hemangiosarcoma 3. microangiopathies 4. splenic/LVR dz |
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echinocyte-photo
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echinocyte
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echinocyte
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evenly spaced, short projections from RBC
DDx: 1. artifact 2. electrolyte depletion/dehydration 3. lymphoma 4. Rattlesnake bite 5. normal in pigs |
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crenation
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artifactual formation of echinocytes
-old blood -slow drying blood films (high humidity) -EDTA tube underfilled |
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ghost cells-photo
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ghost cells
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ghost cells
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RBCs lysed in bloodstream
Hb lost=very pale only in very acute IV hemolysis |
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blister cell-photo
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blister cell
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blister cell
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intact, round clear "blister" on edge of RBC
DDx: 1. oxidizing agents (onions, red maple) 2. Fe deficiency 3. RBC enzyme deficiency |
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keratocyte-photo
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keratocyte
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keratocyte
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RBC with ruptured blister
membrane projections DDx: 1. oxidizing agents (onions, red maple) 2. Fe deficiency 3. RBC enzyme deficiency |
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eccentrocyte-photo
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eccentrocyte
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eccentrocyte
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cell membrane of RBC fuses and pushes Hb to one side
DDx: oxidative damage |
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target cell-photo
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target cell
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target cell (codocyte)/leptocyte
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RBC with excess membrane; folded
DDx: 1. Regenerative anemia 2. Fe deficiency 3.LVR dz |
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stomatocyte-photo
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stomatocyte
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stomatocyte
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bowl-shaped macrocytic RBC with slit like area of central pallor
DDx: 1. breed disposition 2. artifact in thick regions |
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rouleaux-photo
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rouleaux
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rouleaux
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"stack of coins" RBCs
DDx: 1. horse 2. low levels in cat/dog 3. increased PP |
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agglutination
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clusters of RBCs d/t Ab cell bridging
DDx: 1. IM-dz 2. mismatched transfusion |
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Differentiate btwn rouleaux and agglutination?
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1. few saline drops on slide
2. few drops whole blood 3. swirl 4. immediately inspect microscopically 5. Rouleaux disappears |
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Heinz bodies-photo
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Heinz bodies
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Heinz bodies
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denatured Hb precipitated out @ cell membrane
DDx: oxidative damage Romanowski stain: pale cyto NMB stain: dark, round basophilic |
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heinz-NMB photo
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heinz body
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Heinz body DDx
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Cat:
1. up to 10% normal 2. lymphoma 3. hyperthyroid 4. DM 5. Renal Failure |
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Heinz body significance
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1. decreased deformability/lifespan
2. IV hemolysis (less common) 3. spherocyte formation with HB removal 4. large # -->HB hemolytic anemia |
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Howell-Jolly body photo
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Howell-Jolly bodies
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Howell-Jolly bodies
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small piece of nuclear material left in RBC-single dark basophilic structure
DDx: 1. regenerative anemia 2. splenic dysfxn 3. splenectomy 4. a few in cats ok |
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nRBC
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metarubricye
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appropriate metarubricytosis
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1. intensely regenerative anemia (high polychromasia)
2. regne anemia in Llamas w/out polychromatophils |
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inappropriate metarubricytosis
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1. no reticulocytosis
2. nRBC are disproportionate to the degree of regeneration DDx: 1. Splenic dysfxn inc hemangiosarc 2. Extramedulary splenic hematopoeisis 3. BM damage/dz -neoplasia -erythroleukemia (cat) -trauma -hypoxia -endotoxemia -lead toxicity -myelofibrosis |
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late stage nrbc--photo
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late stage nRBC
cytoplasm: -light blue to orange nucleus: -eccentric -condensed -homogeneous -basophilic |
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early stage nRBC-photo
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early stage nRBC
cytoplasm: -basophilic, thin (grey to blue) nucleus: -large -coarse chromatin |
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basophilic stippling-photo
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basophilic stippling
residual RNA aggregates in RBC small fine basophilic dots w/ Romanowski stains |
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appropriate basophilic stippling
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1. typical ruminant regenerative anemia
2. marked regeneration in cats/dogs |
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inappropriate basophilic stippling
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without appropriate regenerative response:
1. lead toxicity 2. dyserythropoiesis (abn RBC production) |
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distempter inclusions-photo
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distemper inclusions
-Diff-quick: pale blue-magenta round structures -in RBCs, WBCs, epi from bladder, vagina, conjunctiva -viral aggregates -acutely affected dogs |
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canine m. haemocanis photo
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Mycoplasma haemocanis in dog
-dots, rings, chains of cocci on surface of RBC, in plasma -low pathogenicity -secondary IMHA sometimes seen |
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feline m. haemofelis photo
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Mycoplasma haemofelis in cat
-usually in dots on outer edge -pathogenic: Feline infectious anemia -acute infections cause severe regenerative, hemolytic anemia |
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cattle m. wenyonii photo
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mycoplasma wenyonii in cattle
-low pathogenicity -may be present in high numbers w/out anemia |
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pig m. haemosuis photo
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mycoplasma haemosuis in pig
-pathogenic esp in piglets |
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Cytauxzoon felis CS
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1. tick bite
2. severe non-regenerative anemia 3. sepsis-like signs -leukopenia -thrombocytopenia -shock |
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Cytauxzoon felis Stages
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1. tissue stage: schizonts
2. RBC stage: pyroplasms |
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cytauxzoon felis photo
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Cytauxzoon felis in cat
-very small round to oval dots -pink inclusions stain better w/ more blue soln |
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Canine Babesiosis CS
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1. Hemolytic anemia (+/- IMHA), EV and IV
2. Thrombocytopenia 3. Fever 4. Hyperglobulinemia 5. Splenomegaly |
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babesia canis-photo
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Babesia canis in dog
-tick transmitted -merozoite in RBC -tear drop shaped organism with pale blue cytoplasm B. canis vogeli is low virulence (high prevalence in greyhounds) -dot like nucleus (reddish) |
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babesia gibsoni-photo
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babesia gibsonii in dogs
-moderate virulence -high prevalence in fighting dogs -small round-oval "signet ring" with red nucleus -thin cytoplasm -higher concentrations in capillaries |
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theileria CS
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1. lympadenopathy
2. fever 3. mild anemia -pathogenic in horses, cattle, sheep outside US -less pathogenic in cattle, deer, elk inside US |
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theileria photo
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Theileria
small ring, comma or dot shapes within RBC dot-like nucleus and pale interior |
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Anaplasma marginale cattle photo
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Anaplasma marginale in cattle
-highly virulent in naive adults -severe EV hemolytic anemia post parasitemia peak -small basophilic dogs @ cell periphery -can have more than 1 per RBC |
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T. cruzi photo
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Trypanosoma cruzi
-dogs and cats free parasite in the blood -pathogenic -causes cardiomyopathy |
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plasma
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liquid portion of blood
includes 1. albumin 2. globuins 3. clotting factors (inc fibrinogen) |
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serum
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fluid portion post clotting
contains: 1. albumin 2. globulins used for serum chemistry, inc TPP |
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Increased total plasma protein DDx
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1. artifact (lipemia, hemolysis, hyperglycemia)
2. Relative: dehydration/hemoconcentration, increased PCV, BUN etc 3. Absolute: greater production of globuins -antigenic stimulation -monoclonal gammopathy 3. Absolute: hyperfibrinogenemia-inflammation indicator in LA |
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Plasma fibrinogen ratio >15
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increase due to dehydration
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plasma fibrinogen ratio <10
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increase due to inflammation
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Decreased total plasma protein DDx
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1. relative: hemodilution (fluid therapy)
2. absolute: loss -blood loss -protein loss from kidney, GI, burn, 3rd spacing 3. Absolue: dec production -LVR failure -immunodeficiency 4. Absolute: failure of passive transfer in neonates |
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