Blood Cells Flashcards
(150 cards)
1
Q
6 yo FN dog with septic arthritis and cellulitis (infected joint and infected skin around the joint). Key CBC results. Low WBC count and low neutrophils. How soon should we repeat the CBC to monitor response to antibiotic therapy for this patient?
A
She has neutropaenia. She has some bands (immature neutrophils but not higher than normal). Neutrophils last 10 hours in circulation. Marrow storage capacity for neutrophils is 5 days (in health). Marrow can increase neutrophil production in response to an infection 2-3 days- just looking at output.
How soon should we repeat the CBC to monitor response to antibiotic therapy for this patient? 3-4 days would tell us whether the marrow is producing neutrophils properly. 48 hours would tell us if marrow response is hastened. 7 days is too long because we want to see if we have controlled demand before our numbers stabilize because we could miss a severe neutropaenia. 12 hours!! The key number is they only last 10 hours in circulation. Numbers are already lower, storage is already depleted. Am I going to get more severely neutropaenic before the 2-3 day point where the marrow kicks out more? Or 4-6 days when fully matured? Already neutropaenic, we want to ensure animal is not high risk for septacaemia. We want it to be fairly stable from antibiotics and start to rise after a couple of days.
2
Q
Haematopoiesis
A
Production of blood cells. Haem- blood, poiesis- to make
3
Q
Where are blood cells produced? Early embry? Foetus? Neonate? Adult? In disease?
A
Early embryo- yolk sac Foetus- liver, spleen, bone marrow Neonate- liver and bone marrow Adult- bone marrow Spleen and Liver with disease in adult
4
Q
So rubriblast starts the maturation, name the rest? How long?
A
Rubriblast, prorubricyte, rubricyte, metarubricyte, polychromatophil, mature erythrocyte. 3-5 days.
5
Q
How are senescent erythrocytes removed?
A
Phagocytosis by macrophages (major route in health), intravascular haemolysis (minor route in health)
6
Q
Which cells does myelopoiesis include?
A
Eosinophils, basophils, neutrophils, and monocytes. Myelopoiesis is the production of blood cells in the bone marrow.
7
Q
What cells do lymphocytes include?
A
T cells, B cells, and NK cells
8
Q
Where does lymphopoiesis occur? Facts about lymphocytes.
A
Thymus and bone marrow. Lymphocytes are capable of mitosis and transformation. Most have life span of 2 weeks. Recirculate via blood and lymphatics.
9
Q
What does granulopoiesis refer to?
A
Production of granulocytes (neutrophils, basophils, and eosinophils
10
Q
What regulates myelopoiesis?
A
G-CSF (granulocyte colony stimulating factor- cytokine and hormone), GM-CSF (granulocyte macrophage- colony stimulating factor). Increase cell proliferation, differentiation, function
11
Q
What are the cell line specific cytokines?
A
IL-6 neutrophils, IL-5 eosinophils, IL-3 basophils. For example, IL-6 (interleukin) is responsible for stimulating production of neutrophils in the bone marrow.
12
Q
What stimulates bone marrow to release neutrophils?
A
G-CSF, GM-CSF, C5a, TNF-alpha, TNF-bravo.
13
Q
Where are neutrophils found?
A
*Marrow maturation pool, and storage pool (5 days supply). *Blood- circulating pool- free moving in vessels. Marginal pool- loosely adhered to vessels * tissue
14
Q
What are the functions of neutrophils?
A
Predominate leukocyte in most species Phagocytic and microbicidal in tissue. Primarily respond to bacterial infections. Role in tissue necrosis, fungal infections, protozoal infections, foreign body reactions. Respond to chemotaxins e.g. C5a, bacterial products, and prostaglandins
15
Q
What happens to the neutrophil nucleus when it matures? Cytoplasm?
A
Elongates, condenses, and segments. Cytoplasm loses basophilia and gains secondary granules. Myelocyte–> metamyelocyte–> band–> segmented
16
Q
What is the life span of a neutrophil in circulation? In tissue?
A
10 hours in circulation. 24-48 hours in tissue.
17
Q
What is the life span of an eosinophil in circulation? In tissue?
A
minutes to hours in circulation. Tissue unknown.
18
Q
What is the life span of basophils in circulation? In tissue?
A
6 hours in circulation. Up to 2 weeks in tissue.
19
Q
Where do leukocytes go when they die?
A
Phagocytosis by macrophages. Spleen grabs them if they never ended up in the tissue, liver, bone marrow, tissue
20
Q
What controls eosinophil production? How long does it take eosinophils to mature in bone marrow? What is the blood transit time? Who does not have eosinophils? What is the role of eosinophils?
A
* IL-5 is major cytokine controlling production (some tumours produce IL-5, so they stimulate eosinophil production for no reason- T cell lymphoma and mast cells as well) * Maturation in marrow 2-6 days * Short blood transit time 1-26 hours * Rare in avians except raptors * kill helminths and have variable role in hypersensitivity
21
Q
What controls basophil production? How long does it take basophils to mature in marrow? Where are these rare and more common? What is their role?
A
IL-3. Maturation in marrow 2-3 days. Short blood transit time. Rare in mammals- more common in avians. Role in hypersensitivity, rejection of parasites, and haemostasis.
22
Q
How fast do monocytes mature in marrow? Transit time in blood? How long do resident tissue macrophages live? Role?
A
Maturation is rapid 1-2 days (in marrow). Approx 20 hours transit time in blood. Limited recirculating and replication capacity. Resident tissue macrophages live weeks to months. Phagocytic and regulate immune response.
23
Q
What is thrombopoeisis regulated by? How long do they take to mature? Where do 30-40% of platelets hang out? What is the life span? How are they removed?
A
Thrombopoeitin from liver, kidney, and marrow stromal cells. Maturation 2-10 days. Released directly into blood. 30-40% sequestered in spleen. Life span 5-9 days. Removal by phagocytosis by macrophages in spleen and liver. Important role in haemostasis.
24
Q
Leukogram
A
Total leukocyte count, individual leukocyte count, leukocyte morphology (automated or manual)
25
What is a Complete Blood Count (CBC)?
Leukogram, erythrogram, thrombogram, TP and sample appearance
26
What are the leukocytes found in circulation?
Lymphocytes, basophils, eosinophils, monocytes, neutrophils
27
What is a marginating pool vs. circulating pool?
Marginating pool = loosely adherent to vessel Circulating pool= free flowing in vessel
28
How does the bone marrow respond to inflammation?
\* Release of neutrophils from storage pool (neutrophilia) \* release of neutrophils from maturation pool --\> Left shift in blood \* increased neutrophil production--\> left shift in marrow \* accelerated neutrophil maturation--\> toxic change
29
Neutrophilia with stress response
Corticosteroid driven. High cortisol levels causes a change int the leukogram. It causes neutrophilia. A shift (change)- the leukocytes are blocked from migrating out of the tissue- less marginated. Quite a large jump with neutrophils- high cortisol level. Cortisol is a natural anti-inflammatory.
Only a little release from storage pool, shift from marginal pool to circulating pool, reduced emigration from blood to tissue
30
What is a cause of neutrophilia in young animals (especially cats, why?)?
Excitement- adrenaline mediated & young animals
Kittens especially because they have a high marginated count of neutrophils.
No left shift. No toxic change. Just an increase of mature neutrophils.
31
What are some causes of neutropenia?
Overwhelming inflammatory demand, transient margination (endotoxaemia), bone marrow disease (not producing neutrophils because of some sort of disease process- lots of examples- marrow infiltrated with tumour cells, end stage lymphoma- no room to make neutrophils, insult that causes damage to bone marrow- because fibrosed and full of fat without the haemopoeitic tissue; chemotherapy- temporarily shuts down production), immune mediated destruction (body can attack neutrophils or thrombocytes, and of course red cells, etc. can be separate event or at the same time)
Endotoxaemia (some nasty infection somewhere, won't rebound without having tissue inflammation)- because the neutrophils are getting sticky to the vessels. Shift into the marginating pool instead of the circulating pool. So they are not in the middle where we are blood sampling. 6-12 hours later, they can then become back to normal.
32
What is a neutrophil left shift?
Increased immature neutrophils in blood. \* usually bands \* regenerative left shift (mature \> immature) \* degenerative left shift (immature \> mature)
If you see a degenerative left shift, poor prognosis- animal more likely to succumb to infection. Animal's bone marrow can't keep up.
(if you are see myeloblasts, you should be worried about leukaemia- such an early stage)
33
What is regenerative left shift?
Mature \> immature
34
What is degenerative left shift?
Immature \> mature
35
If you have a high WBC count, high neutrophil count and high bands count, what does this mean? Or it can also be just high bands count and low or normal neutrophils, bands, metamyelocytes. (recall: you won't get a band count unless someone has looked at the smear)
What is bands are about the same as our neutrophils. Add up bands and metamyleocytes and compare to neutrophil count. If they add up to more than?
Neutrophil left shift
- second question: degenerative.
36
What processes in a patient cause a neutrophil left shift?
\* Indicates inflammation = high demand for neutrophils \* reflects release from maturation pool \* can also occur with myeloproliferative disease e.g. chronic myeloid leukaemia
37
What causes a degenerative left shift?
Indicates overwhelming inflammatory demand. More guarded prognosis.
Be careful with cows as they have a small storage pool. So if you see degenerative left shift with a cow, there is still some sort of infection, but not as poor of a prognosis as a dog.
38
Cattle with acute inflammation can show neutropenia with severe left shift, why?
They have a small neutrophil storage pool
39
What is the life span of lymphocytes?
Weeks to years (depending on their function. For example, the memory cells hang around for a long time).
40
What causes lymphocytosis?
Chronic antigenic stimulation (vaccination), adrenaline/ excitement (young animals: \<12 months, often under 6-8 months, rare in adults. Horses especially)- same process that causes neutrophils to move into circulating pool does the same with lymphocytes (so often neutrophilia and lymphocytosis), lymphoid neoplasia, hypoadrenocorticism (low cortisol levels)
41
What causes lymphopenia?
\* Glucocorticoids/ Stress (high cortisol levels. If it doesn't have lymphopenia, probably not a stress leukogram. reduced release from LN and spleen, lympholysis of uncommitted Lymphocytes- particularly at high doses) - recall: Cortisol reduces inflammation
\* Acute inflammation- is it directly inflamm. process or stress? We don't know, but we usually see it.
\* Loss of lymph fluid- chylothorax, enteric neoplasia, protein losing enteropathy (because we are not getting that recirculation of lymphocytes back into the blood)
42
What are some functions of monocytes?
\* Provide macrophages to tissue
\* Phagocytosis- foreign material, dead cells, less efficient for microbes
\* Immune regulation- source of cytokine & chemotactic factors, present antigen to T lymphocytes, perform antibody dependent cytotoxicity
43
What are some causes of monocytosis?
\* Acute or chronic inflammation
\* Glucocorticoids/ Stress (only seen in dogs)
\* Myeloproliferative disease e.g. myeloid leukaemia
44
What are some causes of monocytopenia?
Clinically insignificant as many healthy animals have very low numbers of monocytes in the blood
45
What are the functions of eosinophils?
\* Kill helminths \* Suppress hypersensitivity \* Promote inflammation (allergies)
46
What are some causes of eosinophilia?
\* Worms- parasitic infection- endo and ectoparasites \* Wheezes and whelts- allergies & hypersensitivity \* Weird diseases (paraneoplasic- lymphoma, mast cell tumour; hyperesoinophilic syndrome; eosinophilic leukaemia; eosinophilic granuloma complex)
47
What are some causes of eosinopenia?
\* Glucocorticoids/ Stress (lymphopenia, mature neutrophilia.. may help us decide it is a stress leukogram)
\* Can be incidental
48
What are the functions of basophils?
\* Histamine release
\* Promote lipid metabolism
\* Haemostasis
\* Parasite control
49
What are some causes of basophilia?
\* Stress in birds \* often accompanies eosinophilia \* worms- parasitic infection- endo and ecto parasites \* Wheezes & whelts- allergies/ hypersensitivities \* Weird diseases- paraneoplastic (lymphoma, mast cell tumour); hypereosinophilic syndrome; basophilic leukaemia; myeloproliferative diseases e.g. polycythaemia vera
50
What about Basopenia?
Too few in health to recognize basopenia.
51
What are the main differentials for a neutropenia?
Acute overwhelming suppurative inflammation, endotoxaemia, dereased production/ marrow disease, drugs causing myelotoxicity
52
Neutrophil
53
Monocyte
54
Eosinophil
55
Lymphocyte
56
Basophil
57
What cells are these?
Left to right. Erythrocyte, platelet (activated), and leukocyte (can't tell what kind). Scanning micrograph (?)
58
What is the base stem cell for haematopoiesis? What are the next two that it can turn into?
Pluripotent stem cell. Either Myeloid stem cell (either granulocytes or monocyte). OR Lymphoid stem cell- T lymphocyte or B lymphocyte.
59
What are megakaryocytes?
Make our platelets.
60
What happens as erythrocytes mature?
Haemoglobin increases, nucleus condenses, and then is extruded.
61
Why do we get anaemia of chronic disease? Anaemia of inflammation?
Inflammatory cytokines inhibit erythroid cell production. TNFalpha, IL-1, IFN, TGF-beta.
62
What is unique about lymphocyte circulation?
They recirculate via blood and lymphatics.
63
64
Are monocytes granulocytes? What is one way to help identify monocytes?
No. Vacuoles.
65
What cell is this?
Megakaryocyte
66
If an animal develops neutropenia due to transient chemotherapy marrow toxicity, how long before we hope to see neutrophil numbers rise in the blood?
4-6 days
67
What is the delay before we see a regenerative response in the blood in dogs after RBC loss?
3-5 day maturation. The more anaemic they are the faster it happens. This is talking about rising above the normal range (bone marrow is always regenerating erythrocytes). It won't be ramped up until 3-5 days.
68
69
What is the pattern on an acute inflammatory leukogram?
\* Neutrophilia (ALWAYS) (release of neutrophils from storage pool, +/- from maturation pool, + increased production with time)
\* +/- Toxic change
\* +/- left shift
\* +/- monocytosis
So... high White cell count, high neutrophils, and high bands possibly. High total solids possibly.
70
What diseases might cause an acute inflammatory leukogram?
A focus of suppurative inflammation or sepsis e.g. infected wound, pneumonia, pyelonephritis. Neutrophilia with inflammation = release of neutrophils from storage pool +/- release from maturation pool.
71
What species variations occur with acute inflammatory leukograms?
\* Cats and dogs often have WBC 10-30 x 10^9/L with inflammation
\* Cattle may only show hyperfibrinogenaemia with no inflammatory leukogram with acute infections (we look for acute phase protein responses- esp. mild inflammation- no leukogram change)
\* Horses may have moderate leukocytosis (compared to dogs and cats) and left shift response, often WBC 7-20 x 10^9/L with inflammation
72
What would you see on a severe acute inflammatory leukogram?
\* Leukaemoid response (a marked change, in cats and dogs esp. 70 x 10^9 WBC count)
\* Marked neutrophilia- 50-100 x 10^9/L
\* Regenerative left shift (Mature\>Immature)
- bands
- metamyelocytes
- +/- Myelocytes
(Increase in total solids as well)
\*\* marked does not mean a poor prognosis, looking at regenerative or degenerative left shift helps us determine prognosis\*\*
73
What diseases might cause a severe acute inflammatory leukogram?
A focus of intense suppurative inflammation or sepsis e.g. necrotic tumour, pneumonia, pyothorax, peritonitis, pyometron
DDx: Myeloid Leukaemia (severe inflamm. leukograms, must entertain especially if you can't find an inflammatory focus)
74
What might you see in an overwhelming inflammatory leukogram?
Neutropenia, degenerative left shift ( Immature \> mature), Lymphopenia, +/- Monocytosis
\*\* we decide if it is overwhelming based on neutropenia level and degenerative left shift-- not on the lymphopenia or monocytosis (if present)\*\*
75
What diseases might cause an overwhelming inflammatory leukogram?
A focus of acute sepsis e.g. intestinal perforation, ruptured pyometron, endotoxaemia, Gram -ve infections
= Marrow unable to meet demand
DDx: Bone marrow disease
76
What might you see on a leukogram with chronic inflammation?
\* Neutrophilia
\* +/- slight regenerative left shift (but often not because the bone marrow has time to ramp up neutrophils- we often just see mature neutrophilia)
\* +/- Lymphocytosis
\* Monocytosis (macrophages are important in chronic inflammation- sometimes with acute inflamm. too)
77
What diseases might cause a chronic inflammatory leukogram?
A focus of chronic inflammation e.g. Severe pyoderma, necrotic neoplasm, chronic hepatitis
In chronic inflammation, all the pools are expanded- mitotic + maturation + storage
78
What might you see on a Glucocorticoid/ Stress Leukogram?
\* Lymphopenia (most consistent finding in all species)\*\* (important, if you don't see lymphopenia, then it is not a stress leukogram)\*\*
\* Neutrophilia (more neurophils in the circulating pool from the marginating pool)
\* Eosinopenia (reduced release from marrow)
\*Monocytosis (dogs) (shift from marginating to circulating pool)
79
Why would you see lymphopenia, neutrophilia, eosinopenia, monocytosis in a glucocorticoid or stress leukogram? What would you not see?
Decreased release from nodes, margination
\* Neutrophilia (heterophilia in birds- just refers to pinky color- not neutral)- increased release from storage pool, shifts from marginating to circulating pool (express less adhesion factors)
\* Eosinopenia- decreased release from bone marrow
\* Monocytosis- shift from marginating to circulating pool
\* No left shift or toxic change
80
What might this hypersegementation of a neutrophil indicate?
Glucocorticoid/ Stress. Corticoid steroid response. Neutrophils are able to age longer in the blood. Hypersegmented = right shifting. (stress response going on for more than a day- recall: neutrophils only last about 10 hours in circulation)
81
What is the pattern for physiological leukocytosis?
Adrenalin/ excitement mediated
\* Neutrophilia
\* Lymphocytosis
\* +/- monocytosis
\* ONLY young animals \<12 months
\* no left shift or toxic change
82
What are the mechanisms of physiological leukocytosis?
Neutrophilia- shift marginating to circulating pool (increased blood pressure and HR)
\* Lymphocytosis and monocytosis- same as neutrophils
\* seen mostly in young healthy animals Cat \> Horse \> Cow \> Dog
\* expect to return to normal quickly, can occur postprandially in pigs (post meal), concurrent lymphocytosis in most cases, mild heterophilia in birds
83
What would you see with Granulocytic Hypoplasia on a Leukogram? First of all, what is granulocytic hypoplasia?
A primary marrow disorder
\* Persistent neutropenia with no left shift (\>5 days)-- giving it time to respond (4-6 days when marrow responds).
\* Caused by bone marrow production problem
e.g cyclic neutropenia of Grey Collies (defect in neutrophil production, produce them and then stop and then produce them and then stop-- erythrocytes don't tend to fluctuate as much because they have a longer life span), Immune mediated neutropenia (targeting neutrophils, sometimes just segmented or sometimes immature as well), drug toxicity, myelodysplastic syndrome (like leukaemia- genetic defect in the stem cells in the marrow- they start producing abnormal cells- marrow is busy but nothing is ever a fully functional matured cell- not common)
84
What defines a persistent neutropenia? How long should we wait before doing bone marrow evaluation on a neutropenic patient?
4-6 days
85
What would you see on a Hypoadrenocorticism Leukogram (Addisons syndrome)?
Glucocorticoid and mineralocorticoid deficient.
\* Lack of stress leukogram (no lymphopenia) despite chronic or severe illness
\* +/- lymphocytosis
\* +/- eosinophilia
What key electrolyte changes can we see?
\* Hyperkalaemia, hyponatraemia and hypochloridaemia, low Na: K ratio
86
What would you see on a leukogram with Myeloid Leukaemia?
\* Moderate to marked leukocytosis- mature forms- sometimes deformed
\* Many different types
- acute myleloid leukaemia (immature/blastic cells)- differentiated cells, mimics inflammatory leukogram
-- neutrophiliic leukaemia, basophilic, eosinophilic, monocytic, erythroid, and megakaryocytic leukaemias
\*\* Analyser- crazy monocytosis- might be leukaemia\*\*
87
If you saw these cells, what is a possible diagnosis?
Acute Myeloid Leukaemia. this is an immature/ blastic cell. Normal you would see about 20 cells, but they are all over the place. Pinky-red granules, big and round in cytoplasm.
88
What might you see with Chronic Myeloid Leukaemia (CML)?
Chronic= mature cells. CML is difficult to distinguish from "leukaemoid" or severe inflammatory leukogram. Loads of neutrophils and you might see some bands. An animal with a persistent high white cell count and you cannot find a reason for it. Mostly presumptive diagnosis. There is no test. Disease of exclusion. Rule out inflamm. all the other things that cause leukocytosis.
89
Case I: 6 yo F Arabian horse
Low WBC (leukopenia), high bands, low neutrophils (neutropenia), low lymphocytes (lymphocytopenia)
Regenerative left shift.
Degree of left shift could still be mild, but the fact that it is neutropenic- marrow isn't coping well.
SEVERE ACUTE INFLAMMATION. (worrying neutropenic but at least regenerative)
90
Case 2: 9 yo FS Maltese dog
Leukocytosis, high bands, neutrophilia, lymphopenia, monocytosis
Left shift- so not stress leukogram. Marked or mild? Mild.
B. Mild acute inflammation (because not marked left shift and neutrophil count is not extreme because it is a dog. Acute because we have left shifting.)
91
Case 3: 4 yo MC crossbreed dog
Really high WBC, metamyelocytes, high bands, really high neutrophils, normal lymphocytes, monocytes
Severe Acute inflammation (could be acute myeloid leukaemia so not common. Unlikely because not noted to have any atypical cells circuling. Certainly not a mild acute inflamm.)
92
Case 4: 14 yo MN DSH
Really high WBC, really high neutrophils, normal lymphocytes, high monocytes
Not a stress leukogram because there is no lymphopenia. Cats don't tend to do monocytosis with stress leukogram (dog thing). Neutrophil count is high- so may be an active component.
Chronic active inflammation.
93
Case 5: 13 yo FS Rottweiler
Normal WBC, slightly high neutrophils, low lymphocytes, slightly high monocytes, low eosinophils
A stress leukogram. Have lymphopenia. Mature but mild neutrophophilia. Monocytosis. And eosinopenia- classic stress leukogram.
94
Case 6: 3 yo F Limousine cow
Normal WBC, metamyelocytes, high bands, low neutrophils, lymphocytes low, high monocytes
Degenerative left shift. (Could be acomponent of stress because of lymphopenia, but we are left shifted so not going to call it a stress leukogram. Not chronic because too much left shifting. way too many bands and metamyleocytes).
95
Case 7: 5mth M SB horse
high wbc
high neutrophils
high lymphocytes
high monocytes
Could be chronic but we have to consider only 5 months old, so likely physiologic- excitement driven. Not stress because no lymphopenia.
96
Case 8: 3 yo MC golden retriever dog
high WBC (very high), high bands, high neutrophils, very high lymphocytes, very high monocytes (?)
Leukaemia likely because the count is so high. Unusual in inflamm. to get a lymphocyte count about 10-15 in any species. To get a lymphocyte count that is above 100, straight away- leukaemia. (Could be misclassified by person or analyser, but initial thought).
97
Case 9: 5 yo F German Shepherd dog
Increasing numbers of WBCs, metamyelocytes that dropped off, high bands at first and then normal, decreasing neutrophils (still low)
Then she shows us day 10 leukogram: really high platelets, much higher WBC, much higher neutrophils (above range now), Low lymphocytes, high monocytes
Bone marrow disease.
After the serial leukograms?
98
What the analyser cannot look for:
Toxic change, left shift (degree of left shifting- metamyleocytes or just bands, for example), atypical cells, abnormal RBC morphology (can't see spherocytes, schistocytes, acanthocytes)
99
What are toxic neutrophils? Why? When?
Neutrophils that show signs of cytoplasmic immaturity- has not fully matured before it was released from the marrow. The cytoplasm did not mature at the same rate as the nucleus. Why? Hastened or disordered maturation in the bone marrow. When? Infections or intense inflammation. Can be associated with nuclear immaturity (left shifting) or seen in cells with mature segmented nuclei.
\*\* does not have to be a left shift to have a toxic change, it is the more subtle form of a left shift\*\*
100
What are some types of neutrophil toxic changes?
\* Dohle bodies
\* Basophilic cytoplasm
\* Vacuolated cytoplasm
\* Toxic granulation
\* Giant neutrophils
101
What are ring form neutrophils?
\* Low numbers are normal in rodents
\* Can be seen with :
- intense inflammation
- chronic myeloid leukaemia
- myleodysplasia
102
What do hypersegmented neutrophils tell us?
\> 5 segmentations= older neutrophils
\* chronic glucocorticoid exposure (decreased tissue emigration)
\* Seen more in horses
\* Can also be seen with myeloproliferative disease e.g. chronic granulocytic leukaemia
103
What are reactive lymphocytes?
Larger than normal (nucleus 2 x RBC), Increased basophilic cytoplasm, may have few magenta cytoplasmic granules, reflect increased antigenic stimulation, non-specific, often seen in health
104
What pool are we drawing from when we take blood?
Circulating pool. Maybe a few from marginating.
105
What can happen with excitement to neutrophils regarding the different pools?
Neutrophils can move from the marginating pool (attached to tisse) to the circulating pool and give the appearance of neutrophilia (with inflammation for example)
106
What is toxic change?
Cytoplasmic changes to neutrophils. Accelerated neutrophil maturation.
107
What will you definitely not see with a stress response?
Do not see immature neutrophils- bands, metamyleocytes, myleocytes with a corticoid response. No left shift. No toxic change.
108
What do band tells us?
Not cortisol response. There is a left shift. Regenerative? If bands are greater than segmented (neutrophil count), then yes. Neutrophil count can be normal with lots of bands- this would mean inflammation- you get this from a blood smear as the analyzer cannot count the bands.
109
Monocyte
110
Monocyte
111
Monocyte
112
Cat eosinophil
113
Horse eosinophil
114
Dog eosinophil
115
Dog basophil
116
Cat basophil
117
Regenerative or degenerative?
Degenerative
118
What mechanism is NOT involved with Neutrophilia of stress response?
A. Increased bone marrow production
B. Release from bone marrow storage pool
C. Shift from marginal to circulating pool
D. Reduced emigration from blood to tissue
A. Increased bone marrow production.
119
Chronic Inflammatory Leukogram
120
Overwhelming Inflammatory Leukogram
121
Severe Acute Inflammatory Leukogram
122
Acute Inflammatory Leukogram
123
Granulocytic Hypoplasia Serial Leukograms.
No bands. At first looking for inflammation but then by day 7, you realize primary bone marrow disease.
124
Rubricyte (darker chromatin to a lymphocyte- granular chromatin as well)
125
Horse eosinophil
126
Horse monocyte
127
Horse lymphocyte
128
Horse neutrophil.
129
Horse basophil.
130
Dohle Bodies (blue cytoplasm- basophilic)
Toxic neutrophil.
131
Toxic neutrophil. Basophilic.
132
Toxic neutrophil. Toxic granulation. Sepsis likely.
133
Ring form neutrophils. This marrow is struggling with demand.
134
Rabbit heterophil
135
Snake heterophil
136
Birman cat neutrophil and eosinophil
137
Band neutrophils. Even the S. Toxic neutrophils (blue)
138
Botriod nucleus. Seen with heat stroke. Hypersegementation where links fuse in the center.
139
Bar body. Tells us it is a female animal. A little drumstick. Dohle bodies with toxic change.
140
Left- neutrophil- some vacuoles.
Right- monocyte or band.
141
Left- Toxic neutrophil (may be segmented, may be band)
Middle- Band
Right- lymphocyte or rubricyte or metamyleocyte or myleocyte or monocyte. Pattern of chromatin looks very similar to neutrophil. Look at cytoplasm- looks similar to neutrophils as well. Most likely myleocyte with toxic change (round nucleus)- looks like it is about to indent.
142
Left- monocyte (vacuoles)- nucleus is strangely shaped but that's okay because typical of monocytes
Right- granular lymphocyte (low numbers in health)- going to be either a T cell or NK cell.
143
Reactive lymphocytes. Larger than normal nucleus. Clear zone adjacent to the nucleus as well (most likely thinking about producing an Ab- may see in recently vaccinated animal- increased numbers in inflammation as well). Lymphocytes responding to antigenic stimulation.
144
Left lymphocytes- normal. Right lymphocyte reactive.
145
Monocytes eating red cells. This could happen with IMHA (if see with spherocytes, esp.). Or a blood transfusion reaction.
Erythrophagia.
146
Fine chromatin and nucleioli. Blasts- really immature forms of cells. You should not see these in the blood. Myleoblast, monoblast or lymphoblast. If you see more than one, you would think of leukaemia.
147
Mast cells. Should not be in the blood. Round nucleus vs. basophil's ribbony nucleus. If they don't have inflammatory disease, worry about mast cell neoplasia.
148
Swollen neutrophils. Degenerate neutrophils. Neutrophil that has phagocytosed bacteria.
149
Dohle bodies. But they could also be Distemper Virus inclusions. However erythrocytes have the same blue inclusions, so diagnosed with Distemper.
150
Could be stress leukogram but it has bands. Left shifted. Not leukaemoid (not above 150). Acute Inflammation. (Regenerative left shift, not neutropenic so not overwhelming)
