haematology wk 1 (CBC, cell morphology, erythrocytosis) Flashcards by Lucy Forgan

which type of tissue is blood?
a. epithelial
b. connective
c. muscle
d. nervous

b. connective - it supports other tissues/organs in the body

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what is in each layer of this tube of centrifuged blood?

A - plasma
B - platelets and leukocytes (WBCs)
C - erythrocytes (RBCs)

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what percentage of the total body weight of an animal does blood make up?
a. 1-3%
b. 5-10%
c. 20%

b. 5-10% - this is important especially for smaller patients, don’t try and draw 10ml from a 120g cockatiel with 6 -12 mls of blood

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(this varies from species to species) - in a dog, what portion blood is made of erythrocytes?
a. 10-15%
b. 33-35%
c. 50-70%
d. 80-90%

b. 33-35% (varies from breed to breed too, greyhounds are more like 50-65%)

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The proportion/percentage of blood made up of erythrocytes is called:
a. Haemoglobin concentration
b. Packed cell volume (PCV) or haematocrit
c. Mean corpuscular volume
d. Haemolysis

b. Packed cell volume (PCV) or haematocrit (both measure the same thing, different methods)

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what does haematopoiesis mean?

the formation of blood cells (haemato = blood, poesis = to make)

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which is the primary site of haematopoesis in adults?
a. spleen
b. kidney
c. bone marrow
d. liver

c. bone marrow

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which is the major haemotopoetic organ during foetal development, and a site for extramedullary (non bone marrow) haematopoiesis / EMH in adults?
a. spleen
b. kidney
c. bone marrow
d. liver

d. liver

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which organ produces EPO (erythropoietin), the hormone that signals for red blood cell production?
a. spleen
b. kidney
c. bone marrow
d. liver

b. kidney

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where do lymphocytes get produced and mature?
a. bone marrow
b. lymph nodes
c. thymus

b. lymph nodes

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which organ removes old/damaged RBCs? (note - can also serve as a site of extramedullary haematopoiesis / EMH, and lymphocyte production)
a. bone marrow
b. lymph nodes
c. thymus
d. spleen

d. spleen

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where do T cells mature and differentiate?

the thymus (after starting in bone marrow)

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what is erythropoiesis?

the production of red blood cells (erythrocytes)

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what is erythropoietin (EPO) released from the kidneys in response to?

hypoxia 😨 (low oxygen levels) in the blood
*this can be due to less red blood cells, BUT not always

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what is a metarubricyte?

the last red blood cell form with a nucleus, should NOT in circulation - indicates extremely severe regenerative anaemia or cancer

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what is a reticulocyte?

an immature red blood cell - these are a little bit bigger than the mature form and contain less haemoglobin

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who’s red blood cells?
- large, biconcave disks with a prominent central pallor
(dog, cat, horse, ruminant, deer, camelid, birds/reptile/fish)

dog! these are the only animals with a central pallor

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who’s red blood cells?
- smaller, display anisocytosis (variation in cell size)
- lack prominent central pallor
(dog, cat, horse, ruminant, deer, camelid, birds/reptile/fish)

cat! these guys are the only ones that display anisocytosis (variation in cell size) as a normal feature

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who’s red blood cells?
- lack central pallor
- often form linear and sometimes branching chains called rouleux
(dog, cat, horse, ruminant, deer, camelid, birds/reptile/fish)

horse :)

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who’s red blood cells?
- spherical to irregular shape, smallish
(dog, cat, horse, ruminant, deer, camelid, birds/reptile/fish)

ruminant - irregular shape

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who’s red blood cells?
- sickle shaped, without health issues
(dog, cat, horse, goat, deer, camelid, birds/reptile/fish)

deer

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who’s red blood cells?
- oval or elliptical shaped
(dog, cat, horse, goat, deer, camelid, birds/reptile/fish)

camelid - the oval shape increases surface area, improving gas exchange for high altitude environments

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who’s red blood cells?
- has a nucleus
- typically oval shaped
(dog, cat, horse, goat, deer, camelid, birds/reptile/fish)

birds/reptiles/fish - these guys are the only ones with a nucleus in their RBCs!

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what are the different types of cells found in blood (cellular components?)

erythrocytes (RBCs
leukocytes (WBCs)*
platelets (called thrombocytes in birds)

*neutrophils, eosinophils, basophils, lymphocytes and monocytes

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what is in plasma? (non cellular blood components)

- water - plasma proteins (albumin, fibrinogen, globulins) - dissolved solutes (nutrients, gases, hormones, waste products, ions)

do you see haemoglobinurea and haemoglobinaemia with a. intravascular haemolysis b. extravascular haemolysis

a. intravascular haemolysis haemoglobinurea = pink pee haemoglobinaemia = pink plasma

what does CBC stand for?

complete blood count - also known as haemogram or full blood count

Which type of blood collection tube/anticoagulant is most commonly used when performing a CBC? a. Red top (no anticogulant) b. Blue top (citrate) c. Purple top (EDTA) d. Green top (heparin)

c. Purple top (EDTA) - EDTA is an anticoagulant :)

When should a blood smear be prepared in relation to performing a CBC? a. Immediately after drawing blood from every patient b. Only if the analyzer shows abnormal results c. Only if the sample is being sent to a laboratory d. Only if the animals shows clinical signs of illness

a. Immediately after drawing blood from every patient - cells can be misidentified by the analyser machine if they are abnormally sized or coloured

what does HCT stand for?

haematocrit - the calculated version of PCV

what does Hb stand for?

Hb = haemoglobin concentration (the amount of haemoglobin per litre of blood)

what does RBC stand for?

RBC = red blood cell count/concentration (number of RBC's in a litre of blood)

what does absolute retics stand for?

absolute retics = the percentage of reticulocytes (immature RBC's) that are in the blood) - shows how responsive the bone marrow is

what does MCV stand for?

MCV = mean cell (or corpuscular) volume - this gives an indication of cell size

what does MCH stand for?

mean cell (corpuscular) haemoglobin - the average amount of haemoglobin per RBC. MCHC is easier to understand, ignore this one lol

what does MCHC stand for?

mean cell haemoglobin concentration - the concentration of haemoglobin per litre of RBCs

what does nRBC stand for?

nucleated red blood cell - indicates immature RBCs with a nucleus (metarubricytes). not normal. typically seen in extreme regenerative anaemia or bone marrow disease

what does a high MCV indicate? a. macrocytosis b. normocytosis c. microcytosis

a. macrocytosis - probably reticulocytes, these are bigger than mature RBCs *MCV = mean cell volume

what does a low MCV indicate? a. macrocytosis b. normocytosis c. microcytosis

c. microcytosis - probably iron deficiency (not enough haemoglobin) *MCV = mean cell volume

what does increased MCHC indicate? a. hyperchromic RBCs (too much haemoglobin)* b. normochromic RBCs c. hypochromic RBCs (not enough haemoglobin) *note - having too much haemoglobin in a cell is physiologically impossible, instead indicating haemolysis or the presence of interfering substances in the blood

a. hyperchromic RBCs (too much haemoglobin)*

what does a low MCHC indicate? a. hyperchromic RBCS b. normochromic RBCs c. hypochromic RBCs

c. hypochromic RBCs - not enough iron, or too many reticulocytes

Which of these parameters is a measure of cell size? a. PCV b. MCV c. MCHC d. MCH e. RBC

b. MCV - mean cell (corpuscular) volume

Which of the following changes would you expect on the CBC (complete blood count) of an animal with macrocytic anaemia? a. Decreased MCV b. Increased MCV c. Decreased MCHC d. Increased MCHC

b. Increased MCV - macrocytic = the cells are larger than normal

If an animal loses blood and their PCV decreases, which of the following CBC parameters would you expect to decrease as well? a. RBC only b. Hb only c. RBC and Hb d. MCHC

c. RBC and Hb - low PCV means there are less red blood cells per litre of blood, and as there are less cells containing haemoglobin, Hb (the amount of haemoglobin per litre) will also decrease

what are the five focus points used to assess red blood cells in a blood smear?

- size - shape - colour - number - additional features?

The term use to describe variation in cell size is: a. Anisocytosis b. Macrocytosis c. Microcytosis d. Normocytosis

a. Anisocytosis

which animal species typically exhibits variations in red cell size (aniocytosis)? a. Bovine b. Canine c. Equine d. Feline e. Porcine

d. Feline

what does polychromasia mean (and indicate?)

polychromasia = variation in cell colour - indicates presence of immature RBCs (these stain bluer due to residual RNA)

what kind of poikilocyte (weird shaped RBC)? - multiple, irregularly shaped, blunt, finger like projections from their cell membrane a. echinocytes (crenated cells / burr cells) b. schistocytes c. acanthocytes (spur cells) d. keratocytes (blister cell, helmet cell) e. spherocytes

c. acanthocytes - thought to occur due to changes in phospholipid/cholesterol concentrations in the cell membrane

what kind of poikilocyte (weird shaped RBC) is commonly seen in... - liver disease in cats - cancer in dogs - iron deficiency anaemia in dogs - normal in young ruminants

acanthocytes!

what kind of poikilocyte (weird shaped RBC)? - multiple short, blunt, evenly spaced surface projections a. echinocytes (crenated cells / burr cells) b. schistocytes c. acanthocytes (spur cells) d. keratocytes (blister cell, helmet cell) e. spherocytes

a. echinocytes! also known as crenated cells or burr cells

what kind of poikilocyte (weird shaped RBC) is most commonly seen due to... - slow drying of blood smears, underfilling EDTA tubes, improper smearing technique (esp in cats) - hypokalaemia (low blood potassium) - hypernatremia (high blood sodium) - chronic kidney disease - dehydration (also snake envenomation, liver disease, inherited erythrocyte abnormalities, drugs)

echinocytes!

which of the following poikilocytes are fragments of red blood cells? a. echinocytes (crenated cells / burr cells) b. schistocytes c. acanthocytes (spur cells) d. keratocytes (blister cell, helmet cell) e. spherocytes

b. schistocytes - these are normally formed due to mechanical damage to the RBC in circulation (often something weird on the vessel wall (intravascular trauma))

which of the following poikilocytes is usually associated with - disseminated intravascular couagulation (DIC, fancy talk for blood clots) - haemangiosarcomas (blood vessel wall cancer) - vasculitis (also glomerular disease, portosystematic shunts, burns, intravascular haemolysis, copper toxicity in sheep, fragmentation of weak cells exposed to normal vascular forces (such as iron deficiency)) OPTIONS - acanthocytes, echinocytes, schistocytes, keratocytes, spherocytes

schistocytes - those associations all would cause RBC damage, leading to fragments of them in circulation

which of the following poikilocytes are RBCs with a blister like vesicle, which can burst giving a projection on either side? a. echinocytes (crenated cells / burr cells) b. schistocytes c. acanthocytes (spur cells) d. keratocytes e. spherocytes

d. keratocytes (otherwise known as helmet cells / blister cells - usually caused by oxidative damage, stress or trauma

which of the following poikilocytes are often associated with - oxidative damage - heinz body haemolytic anaemia - acetaminophen toxicity in cats, onion/garlic poisoning in dogs, red maple leaf toxicity in horses - mechanical injury from DIC or vasculitis - iron deficiency - liver disease (also thermal injury, zinc toxicity, uraemia, inherited membrane disorders, artefact of sample handling) OPTIONS - acanthocytes, echinocytes, schistocytes, keratocytes, spherocytes

keratocytes - often seen alongside shistocytes, acanthocytes or spherocytes in conditions causing mechanical or oxidative damage

which of the following poikilocytes are formed by macrophages partially removing the cell membrane due to the presence of antibodies? a. echinocytes (crenated cells / burr cells) b. schistocytes c. acanthocytes (spur cells) d. keratocytes (helmet cells / blister cells) e. spherocytes

e. spherocytes! after losing a portion of the cell membrane, they can't retain their disk shape and become spherical with no central pallor

which poikilocyte is associated with - immune mediated damage!! (autoimmune, or secondary to infections, drugs or neoplasia) less commonly - oxidative injury, snake enevenomation, hemoparasites, and transfused or stored RBCs OPTIONS - acanthocytes, echinocytes, schistocytes, keratocytes, spherocytes

spherocytes - these guys basically spell immune mediated haemolytic anaemia (IMHA)

which poikilocytes are characterised by their central haemoglobin being shifted to one side? a. echinocytes (crenated cells / burr cells) b. schistocytes c. eccentrocytes d. keratocytes (helmet cells / blister cells) e. spherocytes

c. eccentrocytes - these cells form due to oxidative damage to their RBC membrane

which poikilocytes are associated with: oxidative damage after ingestion of: - onions/garlic/other allium plants in dogs and cats - brassica species in ruminants - acetaminophen toxicity in cats - red maple leaf toxicity in horses copper poisoning in sheep chemicals (zinc pennies, moth balls/naphthalene, skunk spray in dogs enzyme deficiencies (some animals may have congenital deficiencies in enzymes protecting against oxidative stress, such as glucose-6-phosphate dehydrogenase (G6PD)) OPTIONS: acanthocytes, echinocytes, schistocytes, eccentrocytes, spherocytes

eccentrocytes!

which poikilocytes are RBCs that have excessive cell membrane that results in membrane folding? a. eccentrocytes b. keratocytes c. echindocytes d. leptocytes and condocytes (target cells)

d. leptocytes and condocytes (target cells) - these guys have little clinical importance unless every cell is showing them

which poikilocytes have little diagnostic significance unless almost every cell is showing them, but most commonly forms artefactually with excessive ETDA or with hepatic or lipid disorders? OPTIONS: acanthocytes, leptocytes and condocytes (target cells), schistocytes, eccentrocytes, spherocytes

leptocytes and condocytes (target cells)!

the target cells: - leptocytes (the first stage), RBCs with excessive cell membrane - condocytes - where the membrane folding leads to a dense area of haemoglobin in the centre of the cell which is the arrowhead, which is the arrow?

arrowhead - leptocytes (stage one) arrow - condocytes (look like doughnuts)

which poikilocytes have a central slit-like or mouth shaped pallor in the cell centre? a. eccentrocytes b. keratocytes c. echindocytes d. leptocytes and condocytes (target cells) e. stomatocytes

e. stomatocytes - these are formed due to abnormalities in the cell membrane, need to see lots of them to be worried :)

which poikilocytes are associated with cell membrane abnormalities, commonly seen in Hereditary stomatocytosis described in Alaskan Malamutes, Miniature Schnauzers, and Drentse Patrijshonds Appear transiently with liver disease, electrolyte disturbances, and drug exposure Also seen with improper smear preparation or prolonged sample storage. need to see lots to be worried. OPTIONS: acanthocytes, leptocytes and condocytes (target cells), schistocytes, eccentrocytes, spherocytes, stomatocytes

stomatocytes

what are RBCs with blue dots in the cytoplasm (chunks/aggregations of RNA) showing? a. heinz bodies b. basophillic stippling c. howell-jolly bodies d. nucleated RBCs/metatrubricytes e. siderotic granules

b. basophillic stippling - normal feature of regenerative anaemia in ruminants

which RBC feature is associated with regenerative anaemia in ruminants (and occasionally cats), or lead poisoning? a. heinz bodies b. basophillic stippling c. howell-jolly bodies d. nucleated RBCs/metatrubricytes e. siderotic granules

b. basophillic stippling

what are RBCs with clumps of denatured haemoglobin on the internal surface of cell membranes showing? a. heinz bodies b. basophillic stippling c. howell-jolly bodies d. nucleated RBCs/metatrubricytes e. siderotic granules

a. heinz bodies (aka "boob cells") - these show as a bleb on the cell membrane with normal stains, or blue with the methylene blue stain

which RBC feature is associated with oxidative damage to haemoglobin due to: (insert name here) haemolytic anaemia (cats with acetaminophen/paracetamol toxicity, dogs and cats with onion, garlic and chives poisioning, cats with diabetic ketosis), red maple leaf toxicity in horses, brassica plants in ruminants? a. heinz bodies b. basophillic stippling c. howell-jolly bodies d. nucleated RBCs/metatrubricytes e. siderotic granules

a. heinz bodies (boob cells) - cats can have heinz bodies in up to 10% of their RBCs, their spleen isn't as good at removing them and feline Hb more prone to oxidative damage

what are RBCs with small purple dots (nuclear fragments) showing? a. heinz bodies b. basophillic stippling c. howell-jolly bodies d. nucleated RBCs/metatrubricytes e. siderotic granules

c. howell-jolly bodies - these guys indicate regenerative anaemia

which RBC feature is associated with regenerative anaemia, reduced splenic function and after splenectomy, and chronic steroid therapy in dogs? a. heinz bodies b. basophillic stippling c. howell-jolly bodies d. nucleated RBCs/metatrubricytes e. siderotic granules

c. howell-jolly bodies

a RBC still showing a nucleus, not normally seen in peripheral blood is called a.... a. heinz bodies b. basophillic stippling c. howell-jolly bodies d. metatrubricyte e. siderotic granules

d. metatrubricyte - the last RBC stage with a nucleus

which RBC feature is associated with extreme regenerative anaemia, bone marrow damage or disease (neoplasia, canine parvo, feline leukaemia), non functioning spleen or splenic contraction, lead toxicity, severe hypoxia, inflammation, septicaemia, or a few normally in neonates? a. heinz bodies b. basophillic stippling c. howell-jolly bodies d. metatrubricyte e. siderotic granules

d. metatrubricyte

a mature RBC with chunks of iron granules in the cytoplasm are called... a. heinz bodies b. basophillic stippling c. howell-jolly bodies d. metatrubricyte e. siderotic granules

e. siderotic granules - these are rare but can be seen during haemolytic anaemia or with splenic dysfunction

a RBC feature associated with haemolytic anaemia or splenic dysfunction is... a. heinz bodies b. basophillic stippling c. howell-jolly bodies d. metatrubricyte e. siderotic granules

e. siderotic granules - the iron chunks in the cytoplasm baddies

which erythrocyte arrangement is common in horses, enhanced in animals with hyperfibrinogenaemia (as occurs with acute inflammation) or hyperglobulinemia (as in plasma cell myeloma)? a. agglutination b. roulex formation

b. roulex formation - RBCs grouped together like a stack of coins

which RBC arrangement is usually due to the presence of antibodies on their surface, ie in animals with IMHA (immune mediated haemolytic anaemia), or sometimes after a mismatched blood transfusion)? can result in a falsely increased MCV and falsely decreased RBC count. a. agglutination b. roulex formation

a. agglutination - the IMHA one

the saline dispersion test - what will happen? a. rouleaux will disperse, agglutination will stay clumped b. rouleax will stay clumped, agglutination will disperse

a. rouleaux will disperse, agglutination will stay clumped

what is melena?

dark, tarry stools due to digested blood (GI tract haemorrhage)

what are cells A and B?

A - reticulocytes (polychromatophils - they stain weird) B - basophilic stippling

what are cells C and D showing?

C - nRBC (metarubricyte) D - howell-jolly bodies

what cells are these?

schistocytes

what cells are these?

keratocytes (blister cells, helmet cells)

what cells are these?

acanthocytes (spur cells)

what is erythrocytosis?

too many RBCs - indicated by an increased PCV/haematocrit, RBCs or Hg concentration.

what is the difference between absolute and relative erythrocytosis (increase in RBCs)?

Relative - normal RBCs but decrease in plasma volume, or weird erythrocyte distribution Absolute - increase in RBC mass

which form of erythrocytosis does dehydration result in? a. relative erythrocytosis b. absolute erythrocytosis

a. relative erythrocytosis - RBC numbers are the same, but plasma volume decreases giving an increased RBC to plasma ratio. plasma proteins usually also increased.

you see mild erythrocytosis in an animal exercising, excited, or stressed/adrenaline fueled (fight or flight response) - what do you think caused this?

splenic contraction - this is a response to the above circumstances that releases erythrocytes into circulation. temporary, no clinical significance

what is the difference between primary and secondary absolute (actual RBC increase) erythrocytosis?

primary absolute - RBC production without EPO (cancer, bone marrow disease) secondary absolute - RBC production in response to increased EPO *secondary then spits into appropriate and inapropriate

what is the difference between appropriate and inappropriate secondary (increase in EPO related) absolute erythrocytosis?

appropriate secondary - increased EPO from hypoxia inappropriate secondary - no hypoxia, increased EPO from renal tumors

The primary cause of relative erythrocytosis in domestic animals is: a. Bone marrow hyperplasia b. Decreased plasma volume c. Increased erythropoietin production d. Increased red cell mass

b. Decreased plasma volume - relative erythrocytosis isn't actually an increase in RBCs, it just looks like it compared to normal plasma/blood ratios

haematology wk 1 (CBC, cell morphology, erythrocytosis) Flashcards

(92 cards)