body fluid cytology Flashcards by Jessica Ernst

what is an effusion?

accumulatio of fluid in the pleural, peritoneal or pericardial space

due to increased entry or decreased removal of fluid

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clinical signs

abdominal pain/distension-fluid wave

dyspnea

muffled heart and/or lung sounds

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5 major mechanisms of effusions

increased vascular hydrostatis pressure

decreased plasma oncotic pressure

increased vascula permeability

decreased lymphatic drainage

damage to viscera

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sample handling and preparation

always prepare a slide-eliminates in vitro artifacts

purple top-preserves cellular detail, TP, TNCC

Red top-culture, chem analysis-crea, bili

blood smear technique or line smear technique

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staining

dry slide quickly

prepare several smears

in house Diff-Quik type stain

stain maintenance is important!

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Fluid analysis components

gross appearance (color and turbidity)

total nucleated cell count

cytologic examination

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abnormal colors

pink to red-blood

yellow-urine

green-bile

white-chylous effusion

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turbidity

clear-low cell conc

cloudy-high cellularity or lipid

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TP measurement

refractometer

spin first if cloudy

interference with lipema, hemolysis and icterus

TP breakpoints: <2.5, 2.5-3.0, >3.0

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Total nucleated cell count

automated

in house-hemacytometer

verify counts by smear evaluation

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cytologic evaluation

large mononuclear cells/macrophages

mesothelial cells

lymphocytes

neutrophils

RBCs

eosinophils, mast cells

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mesothelial cells

can occur in large rafts or individually

characteristic brush-like eosinophillic border

often appear reactive

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transudate

normal fluid-scant in SAM, more in LAM

clear and colorless

TP: <2.5 g/dl

cell count: <1,000 cell/ul SAM

<5,000 cell/ul LAM

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transudate cytology

SAM-large mononuclear cell, few non-degenerate neutrophils, small lymphs, RBCs, reactive mesothelial cells

LAM-many more neutrophils

chronicity-fluid irritating-increased neutrophils, more reactive mesothelial cells

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causes of transudate

increased hydrostatic pressure-portal hypertension

decreased oncotic pressure-low protein-hepatic insufficiency, PLE, PLN

decrease clearance of fluid-early heart failure, lymphatic obstruction

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modified transudate

light yellow/clear to slight cloudy

TP: >2.5 g/dl

Cell count: 1,000-5,000 cells/ul SAM

5,000-10,000 cells/ul LAM

cytologic eval: variable/similar to transudate, % of neutrophils and small lymphs may increase

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modified transudate causes

increased vascular permeability

lymphatic/vascular obstruction

mild inflammation

cardiac insufficiency, neoplasia, thrombosis, acute organ torsion, diaphragmatic hernia

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7 yo FS beagle

hx of heart murmur, presented for collapsing episodes, lethargy and distended abdomen

abd fluid: Straw, slightly turbid, TP: 2.9 g/dl, TNCC: 1,022 cells/ul, 77% non-deg neutro, 23% large mononuclear cells

Classification and cause?

modified transudate

cardiac insufficiency

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Exudate

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color: apricot/tan/reddish/orange
turbidity: cloudy/chunky

TP: >3.0 g/dl

Cell count: >5,000 cells/ul SAM, >10,000 cells/ul LAM

Exudate cytologic eval

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characterized by degree of infl, predominate cell type, septic vs non-septic

predominate cell type varies: often neutro, mixed, macs

septic vs non-septic: degenerate neutro (swollen pale nuclei), always look for etiologic agents, culture often needed

exudate causes

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increased capillary permeability

often secondary to infl

chemotactic stimuli

sterile irritants

septic:infectious agents

non-septic: infla of local organs (pancreatitis), sterile irritants (bile), neoplasia

Sandy: 5 yo FS yellow lab

Presented for 2 week hx of lethargy, muffled heart and lung sounds, rads: pleural fluid

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Hemorrhagic effusion

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pink to red/cloudy

TP: >3.0 g/dl

TNN: variable but usually >1,000 cell/ul

Cyto: nucleated cells are similar to peripheral blood

hemorrhagic effusion: contamination vs hemorrhage

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erthrophagocytosis

red cell break down products-hemosiderin, hematoidin

may not see peracute hemorrhage

PCV will be 10-25% that of blood, no platelet, no clotting

hemorrhagic effusion causes

trauma coagulopathies neoplasia-eg hemangiosarcoma

Barrett: 5 yo MN greyhound hx of v, d, anorexia, lethargy, difficulty breathing PE revealed muffled lung and heart sounds

billious effusion

yellow, green brown/opaque TP: \>3.0 g/dl TNCC: often \>5,000 cells/ul

bilious effusion cyto

mixed infl cells-often exudate, primarily neutro and large mononuclear cells presence of yellow, green, blue-black material-in background, in cytoplasma of neutro and large mononuclear cells bilirubin conc: Serum vs fluid

bilious effusion cuaess

rupture/leakage from biliary tract trauma cholelithiasis cholecysitis/cholangitis bile duct carcinoma

uroabdomen

fluid lacks distinct char TP \<3.0 g/dl often \<2.5 g/dl TNCC often \<4,000 cell/ul may become inflamed with time non-septic exudate, septic exudate if associated with UTI

Uroabdomen cytologic eval

varying number of inflammatory cells-neutrophils, large mononuclear cells dx: creat conc (Fluid\>serum) distinct patterns of electrolyte change-hyperkalemia, hyponatremia

uroabdomen-causes

trauma urolithiasis neoplasia of urinary tract

Chylous Effusion

most often occurs in thoracic cavity white to pink and opaque, usually does not clear after centrifugation TP and TNCC-similar to modified transudate or exudate

chylous effusion cyto eval

small lymps predominate % neutrophils and large mononuclear cells increase with chronicity may see fine lipid vacuoles in background triglyceride conc: serum vs fluid

chylous effusion causes

idiopathic cardiac insufficiency lympathic/thoracic duct obstruction thoracic duct rupture

Pete: 12 yo MN mixed breed dog presented for respiratory distress thoracic fluid: White/milky TP: 4.6 g/dl TNCC: 1,820 cells/ul 64% lymph, 15% mac, 20% neutro Triglycerides: 1642 mg/dl

chylous effusion, mediastinal mass

neoplastic effusion

light yellow to apricot/clear to cloudy TP: \>2.5 g/dl TNCC: variable

neoplastic effusion cyto eval

presence of neoplastic cells +/- inflammation and hemorrhage must distinguish from reactive mesothelial cells!

neoplastic effusion causes

lymphoma carcinoma mesothelioma

Dixie: 9 yo Missouri Fox trotter mare hx of progressive anorexia, lethargy, mildly increased respiratory effort abd fluid: yellow/slightly turbid TP: 5.2 g/dl TNCC: 5,010 cells/ul cyto: markedly atypical epitheloid cells, marked anisocytosis & anisokaryosis, nuclear to cytoplasmic ratio is often high, rare mitotic figures and signet ring cells

neoplastic effusion

FIP effusion

straw to golden color, tenacious, often thin fibrin strands suspended TP: \>4.0 g/dl TNCC: variable non-septic exudate or high protein modified transudate

FIP effusion cyto eval

non-degenerate neutro, large mononuclear cells, small lymphs often has granular pink (protein) background

Stella 3 yo FS Weimaraner hx of Grade 1 mast cell tumor removed 3 m ago and treated with Mastinib presented for lethargy, vomiting, and distended painful abdomen chem: Protein: \<2.5 g/dl, alb: \<1.5 g/dl abdominal fluid: colorless/slightly turbid, TP: \<2.5 g/dl, TNCC: 690 cells/ul 75% non-degenerate neutro, 22% mac, 3% lymph

transudate, chronic likely due to liver insufficiency or PLN/PLE idiosyncratic reaction to Mastinib

Cody 4 yo MN GSD hx of chronic d and distended abdomen WBC COunt 25.18 (3.88-14.57) Seg neutro: 22.41 (2.1-11.2) Bands: 2.01 (0.0 -0.13) Lymph: 0.5 (0.78-3.36) mono: 0.25 (0-1.2) Eos: 0 (0-1.2) WBC morph: 2+ toxic change abdominal fluid: slightly pinkt/turbid, TP: 5.6 g/dl, TNCC: 49,070 cells/ul, 85% mildly degenerate neutrophils, 16% large mononuclear

leukocytosis, acute inflammatory/steroid leukogram marked neutrophilic exudate culture hepatocellular carcinoma

OPal 16 yo Friesian mare with colic abd fluid: yellow/slightlly turbid TP: \<2.5 g/dl TNCC: 1,640 cells/ul 89% large mononuclear cells, 30% non-degenerate neutrophils, 1% small mononuclear cells

transudate

Susannah 2 yo SF DSH adopted 3 months ago after being held as a stray in a vet clinic, decreased appetite for a week, progressively more lethargic for past 3 days, increased drinking PE: thin with unkempt haircoat, Icteric MM, Febrile, Distended abdomen, FeLV negative WBC count: 17.3 (4.5-15.7) Seg neutro: 15.7 (2.1-13.1) Bands: 0.5 (0.0-0.3) Lymph: 0.9 (1.5-7.0) Mono: 0.2 (0-0.9) eos: 0 (0-1.9) WBC morph: slightly toxic neutrophils HCT: 20% RBC count: 4.6 (5-10) Hgb: 6.4 (8-15) MCV: 42.4 (39-55) MCHC: 32 (31-35) RBC morph: normal Plt: 273 (183-643) Plasma: icteric TP: 7.7 (5.7-7.5) abdominal fluid: pre spin: dark yellow, hazy; post spin: dark yellow, clear TP: 6.7 TNCC: 2,300 Cyto eval: 75% non-degenerate neutro, 14% small lymphs, 11% large mononuclear cells, no etiologic agents, background thick and eosinophilic

FIP leukocytosis with mature and immature neutrophilia, lymphopenia, toxic neutrophils moderate normocytic, normochromic non-regenerative anemia

lady: 13 yo FS American Eskimo dog PE: distended abdomen with fluid wave, febrile, tachycardia, large amount of fluid is collected during abdominocentesis WBC Count: 6.8 (6-17) Seg neutro: 4.6 (3.0-11.0) band neutro: 1.2 (0-0.3) lymph: 0.7 (1-4.8) mono: 0.2 (0.2-1.4) eos: 0.1 (0-1.3) WBC morph: mild toxic change in neutrophils HCT: 44% RBC count: 6.3 (5.5-8.5) Hgb: 14.7 (12-18) MCV: 71.9 (66-77) MCHC: 33.4 (31-34) RBC: normal Plasma: normal PLT: 127 (250-450)

body fluid cytology Flashcards

(47 cards)