Hematology - (Intro through Bone Marrow) Flashcards
1
Q
What is an MCHC?
A
Mean corpuscular hemoglobin concentration
the average amount of hemoglobin in a Red blood cell
2
Q
How do you calculate the absolute nucleated blood cell differential value?
A
Multiply the percent of the nucleated cell count by the total nucleated cell count
3
Q
How do you calculate the absolute reticulocyte count?
A
Multiply the percent reticulocytes by the red blood cell count
4
Q
What is the packed cell volume?
A
The percentage of erythrocytes in whole blood also called the hematocrit
5
Q
What does the Buffy coat contain?
A
leukocytes
nucleated erythrocytes
platelets
6
Q
What does the yellow pigmentation of plasma indicate?
A
Suggestive of icterus due to increase Billirubin concentration in the blood. In large animals may be due to Carotene pigments associated with diet
7
Q
What does a pale opaque plasma pigmentation indicate?
A
Lipemia - may be due to postprandial collection or maybe due to diseases associated with abnormalities in lipid metabolism
8
Q
What does red coloration of the plasma indicate?
A
Due to the presence of hemoglobin in the plasma - the result of hemolysis
9
Q
What are the causes of hemolysis in vitro and in vivo?
A
In vitro due to technique or presence of lipemia
in vivo due to hemolytic anemia
10
Q
What is plasma proteins by refractometry used for?
A
Measures the refractive index relative to distilled water to estimate plasma protein estimation
11
Q
What will artificially increase the plasma protein?
A
Lipids
Urea
glucose
cholesterol
12
Q
What is the total leukocyte concentration?
A
Also known as the total nucleated cell count that detects all nuclei in solutions from which red blood cells have been removed by lysis
13
Q
What does a segmented neutrophil look like?
A
The nucleus is constricted at least one third the width of the nucleus and elongates and can appear curved back on itself
14
Q
How do you Convert percentage to absolute value?
A
Multiply the Total nucleated cell count by the percentage of each leukocyte type to yield the absolute concentration of each type of nucleated cell within the blood sample
15
Q
What does MCV stand for?
A
Mean cell volume - the average size of the red blood cells
16
Q
How do you calculate the hematocrit (PCV)?
A
Multiply the MCV by the red blood cell count and divide by 10
17
Q
How do you calculate the MCHC (mean cell hemoglobin concentration)?
A
Hemoglobin times 100 divided by the percent PCV
18
Q
What is normochromic?
A
Red blood cells appear to be the correct red cell color and therefore the correct hemoglobin concentration
19
Q
What is hypochromic and what is it indicative of?
A
The red cells appear to be paler than normal and therefore less hemoglobin concentration
Iron deficiency anemia!!!
20
Q
What is hyperchromic?
A
Red cells appear to have more Red cell color than normal this would mean an increase in hemoglobin concentration
NO such thing as hyperchromic anemia!!!
21
Q
Which animals have a nucleated oval red blood cell?
A
Birds
22
Q
Which animals have elliptical shaped red blood cells?
A
Camelids
23
Q
What does a high mean sell hemoglobin concentration (MCHC) mean?
A
If increased it is due to erroneously high hemoglobin due to hemolysis, lipemia, or the presence of Heinz bodies
24
Q
What does a decreased mean cell hemoglobin concentration (MCHC) mean?
A
Decreases may be due to iron deficiency but not unless very severe
usually decreases due to the presence of many reticulocytes that are still making hemoglobin
usually associated with the regenerative anemia
25
Which animal has a red blood cell with central pallor and size closest to human?
Dog
26
Which animal has the smallest sized red blood cell?
Goat
27
What does a wide bell curve on and MCV indicative of?
Variability in size of red blood cells
28
What is red cell distribution width (RDW)?
Describes the relative width of the size distribution curve
the standard deviation of most of the erythrocytes divided by the MCV
29
What is Anisocytosis?
Variability in size of red blood cells
30
What is a tight left shifted curve (MCV) indicative of?
Uniform populations of small red blood cells and iron deficiency anemia
31
Reticulocyte concentration
Immature erythrocytes still have organelles for protein synthesis and aerobic metabolism
32
How do you calculate reticulocyte count?
Percentage of reticulocytes counted are multiplied by the RBC count to obtain an absolute reticulocyte concentration
33
0-10,000 reticulocyte count
Non regenerative anemia
34
10,000-60,000 reticulocyte count
Poorly regenerative anemia
35
60,000-200,000 reticulocyte count
Mild to moderate regeneration
36
>200,000 reticulocyte count
Maximal regeneration
37
What is a punctate reticulocyte?
A 12 day old or less reticulocyte that has organelles all throughout them
38
What do refractometers estimate?
Estimate the concentration of solute in fluid
39
If your PCV and total protein are increased what does that indicate?
The patient is dehydrated
40
If the PCV and the total protein are decreased then what does that indicate?
The patient has blood loss
41
What are the two major constituents of the total protein?
Albumin and globulin
42
What are Dohle bodies indicative of?
Toxic neutrophil - young neutrophil
43
What does a red top tube contain and what is it used for?
Does not contain anticoagulant and is used for serum for biochemical profiles and other tests
44
What does the marble top tube contain and what is it used for?
Contains a serum separator (a gel that promotes blood clot formation and separate cells from serum) used for chemistry analysis and serology
45
What does the purple top tube contain and what is it used for?
Contains EDTA (ethlenediaminetetraacetic acid)with a potassium salt - an anticoagulant calcium chelator that preserves cell morphology
used in the CBC, fibrinogen, and reticulocyte count
46
What does the green top tube contain and what is it used for?
Contains heparin, an anticoagulant, that inhibits thrombin and also contains fibrinogen
used in chemistry panels, avian and reptile CBC and chemistry panel
47
What does a blue top tube contain and what is it used for?
Contains citrate, an anticoagulant calcium chelator, used in coagulation tests like PT PTT and FDP
48
What does the gray top tube contain and what is it used for?
Contains sodium fluoride oxalate, an anticoagulant calcium chelator, that inhibit glucose metabolism used for plasma for serial glucose, lactate, & pyruvate
49
What is a reference interval?
A range of normal values in a healthy population
50
Which phase more commonly is the source of error: pre-analytical analytical or post analytical?
Pre-analytical phase
51
What are the two major categories of pre-analytical factors?
Technical effects and biological factors
52
What are technical effects of pre-analytical factors?
Due to sampling technique and specimen management before analysis
53
What are biological factors of the pre-analytical phase?
Inherent with the animal sampled
54
What is a factor of the analytical phase?
Analyzer error
55
What are two factors of the post analytical phase?
Errors in transcription and misinterpretation/misreading results
56
What is a sensitive test?
A test that helps rule out a disease when the result is negative - SNOUT (sensitivity rules out)
57
What is specificity?
A test that rules in a diagnosis by a positive result - SPIN (specificity rules in)
58
What is diagnostic accuracy?
Measures the frequency that a test correctly classifies an animal as having or not having a disease
59
Which stages of the neutrophil are proliferating and maturing?
Myeloblast
progranulocyte
myelocyte
60
Which stages of the neutrophil are maturation only?
Metamyelocyte
band neutrophils
segmented neutrophils
61
How many segmented neutrophils can one myeloblast yield?
16 to 32 segmented neutrophils
62
What causes decreased margination of neutrophils?
Cortisol and epinephrine
63
What does the suffix -penia refer to?
refers to a decreased concentration of the cell type in blood.
64
Cytopenia
refers to a decrease in cell concentration in a nonspecific manner
65
What does The suffixes -philia or -cytosis refer to?
refer to an increased concentration of the cell type in blood.
66
What does a left shift refer to?
Left shift refers to an increased concentration of immature neutrophils in blood.
67
Myeloma
A specific form of neoplasia with plasma cell differentiation
68
What are Dohle bodies seen more commonly in?
Cats
69
What features of the neutrophil are seen as artifact of aged blood?
Cytoplasmic vacuolation and nuclear swelling
70
What is an acquired change associated with ingestion of certain plants containing the toxic substance swainsonine?
Inhibition of lysosomal enzymes - Lymphocyte vacuolation
71
What anomaly contains cells that have an immaturely shaped nucleus (i.e., band or myelocyte form) and no segmented neutrophils are seen in blood films. Eosinophils are also affected and appear as band forms.?
Pelger-Huët anomaly
72
What anomaly causes Neutrophils from affected cats to contain fine eosinophilic to magenta-colored granules?
Birman cat neutrophil granulation anomaly
73
What disorder causes Neutrophils to contain numerous distinct, dark-purple or magenta-colored granules and Lymphocytes also contain granules and vacuoles.?
mucopolysaccharidosis (MPS)
74
What disorder causes Neutrophils to have large, fused, 2.0-mm lysosomes that stain lightly pink or eosinophilic within the cytoplasm and have a slight tendency to bleed, because platelet function is abnormal?
Chédiak-Higashi syndrome
75
What is Leukemia?
Presence of neoplastic cells in the blood or bone marrow
76
What are three features of a toxic Neutrophil?
Increased basophilia of cytoplasm
Presence of Dohle bodies
Cytoplasmic vacuolation
77
What does MPS and GM2 Gangliocydosis result in?
cytoplasmic granulation or vacuolation
78
What are the clinical signs of an animal with mucopolysaccharidosis VI?
```
Dwarfism
Severe bone disease
degenerative joint disease
Corneal edema
Flattened face
```
79
What are the two factors that are balanced in determining Blood Neutrophil Concentration?
Marrow Delivery rate
| Tissue Consumption Rate
80
What is Neutrophilia indicative of?
Inflammation
81
What is a left shift indicative of?
Severe Inflammation
82
What animal does not have a large storage of neutrophils?
Cow
83
In which animal would a Neutropenia be considered an emergency?
Dog
84
What kind of lesion results in very high neutrophil concentrations?
Chronic walled-off inflammatory lesion (Ex: Pyometra or a walled off abscess)
85
What is Leukocytosis/Lymphocytosis indicative of in a cat?
Excitement ("Fight or Flight" response)
86
What is a Lymphopenia indicative of?
Stress in Cats
87
What is the mechanism for Lymphopenia from a stress response?
Steroid induce lymphocyte apoptosis
88
What does a lack of steroid response in a sick animal mean?
Hypoadrenocortism
89
What are the 2 cell type responses to stress?
Lymphopenia
| Neutrophilia
90
What is the stress response in dogs?
Monocytosis
91
What are the three causes of Neutrophilia?
Left Shift - Inflammation --> Combined inflammation and Stress Response
No Left Shift --> Lymphopenia --> Steroid Response
No Left Shift --> No Lymphopenia --> Excitment Response
92
What are the two causes of Lymphocytosis?
Excitement Response
| Lymphocytic leukemia
93
What causes large granular lymphocytes and monoclonal gammopathy?
Ehrlichiosis
94
What are three causes of Neutropenia?
Consumption within inflammatory lesion
Immune mediated destruction
Lack of production by bone marrow - Bone marrow problem (Reversible or Irreversible)
95
What are three causes of Lymphopenia?
Steroid Response
Acute viral infections
Immunodeficiency (Combined Immunodeficiency syndrome of Arabian foals)
96
What are two causes of Monocytosis?
```
Inflammation
Stress Response (Dogs)
```
97
What are three causes of Eosinophilia?
Parasitism
Hypersensitivity
Lesions producing eosinophil chemoattractants (Mast cell tumors)
98
Is there an eosinophilia with a RBC parasite?
NO
99
When do you seen a basophilia?
With an eosinophilia
100
What causes increased neutrophils at 2X the reference interval?
INFLAMMATION
101
Is a macrocytic anemia regenerative or nonregenrative?
Regenerative
102
Microcytic Anemia = ?
Iron deficiency anemia
103
What is macrocytic anemia?
Increase in size of the Red Blood Cells
104
What is normacytic anemia?
The Red blood cells have not changed their shape
| Indicative of Blood Loss Anemia
105
What do you administer to an iron deficient anemia patient? Oral or injectable iron?
injectable iron
106
What is microcytic anemia ALWAYS due to?
Iron deficiency Anemia!
107
What is Polychromasia?
Reticulocytes that the organelles have clumped together (released from the bone marrow within the last 24-48 hours) - THE BONE MARROW IS RESPONDING!
108
Describe a bowl shaped or "Punched out" cell
sharply defined, central clear area, and a thicker rim of hemoglobin
109
Poikilocytes
Abnormally shaped erythrocytes
110
Spiculated erythrocyte
have one ore more surface spicules and include echinocytes, acanthocytes, keratocytes, and schistocytes
111
Schistocytes
Erythrocyte fragments that result from the shearing of red cells by intravascular trauma usually with Fibrin strands
112
Acanthocytes
Few unevenly distributed projections due to changes in lipid concentrations in RBC membrane
113
Keratocytes
One or two quite long spicules often formed by breaking open of "blisters" on a red blood cell - Also associated with iron deficiency anemia
114
Echinocytes - Definition and Cause?
numerous short spicules caused by In vitro formation ( Blood dries slowly - causes the blood pH to change), Electrolyte imbalance, Non-specific diseases, and Rattlesnake envenomation
115
Spherocytes
Ball-shaped Red blood cells
116
What conditions are associated with Acanthocytes?
Hepatic lipidosis
Liver disease
hemangiosarcoma
117
Why does Hemangiosarcoma cause Acanthocyte formation?
The cancer invades the endothelial cells of the blood vessels causing vascular changes
118
What conditions are associated with Schistocyte formation?
```
Intravascular trauma (DIC)
Iron deficiency Anemia
```
119
Does the patient become anemia because of Schistocyte formation?
NO! The red blood cells break apart and reseal
120
What condition is associated with the presence of Spherocytes?
Immune mediated Hemolytic anemia (IMHA)
121
What type of echinocytes are associated with Rattlesnake Envenomation?
Type 3
122
What antibody will cause agglutination of RBCs?
IgM
123
What causes the formation of spherocytes?
partial phagocytosis due to the presence of antibodies on the membrane
124
What are spherocytes associated with?
blood transfusion with the wrong blood type
bee stings
zinc toxicosis
Certain Drugs
125
What can cause intravascular hemolysis?
The MAC complex forming and punching a hole in the RBC membrane
126
Eccentrocytes - Shape changes and cause?
Shifting of hemoglobin to one side of the cells resulting in a clear zone outlined by a membrane
Caused by oxidative damage due to the ingestion of onions in dogs
Often seen with Heinz body formation
127
What erythrocyte morphologies are of little diagnostic significance?
Leptocytes (Folded cells)
Codocytes (Target cells)
Stomatocytes
Torocytes (Bowl Shaped)
128
What is a Torocyte and how is it formed?
Bowl shaped erythrocyte formed by the forces acting on the RBCs in the capillaries
129
Leptocyte - Shape and Cause?
Thin RBCs that tend to fold more easily caused by iron deficiency
130
What is target cell formation associated with?
High Cholesterol in dogs
131
Stomatocytes
Uniconcave erythrocytes with a mouthlike clear area near the cell center
132
What are stomatocytes associated with?
Dwarfism in Alaskan Malamutes, Miniature Schnauzers, Drentse partrijshond
133
What are Heinz bodies associated with?
Hemolytic anemia
| Especially in Cats
134
Basophilic stippling
Blue dots in RBCs that are normal for ruminants
135
What is basophilic stippling associated with in small animals?
Lead poisoning
136
Howell Jolly bodies
nuclear remnant that did not get extruded when the nucleus got extruded from the RBC
137
What are Howell Jolly bodies associated with
```
Regenerative Anemia
Non functioning spleens
Splenectomy
Increased Corticosteroids
Lead poisoning
```
138
What causes the formation of Heinz body
```
Acetaminophen (cats)
Propylene glycol (cats)
Illness in cats
Onions in all species
Cephalosporins (Dogs)
Zinc toxicosis
Copper and Selenium deficiency
Crude oil
Naphthalene (moth balls)
Kale, Cabbage, Rape
Wilted Red maple leaves
```
139
What kind of anemia is basophilic stippling associated with?
Regenerative Anemia
140
At what stage is an erythrocyte no longer able to divide?
Metarubricyte
141
When would you see Prorubricytes and Rubriblasts in the blood?
NEVER!
| Unless there is leukemia
142
What are the stages of an erythrocyte?
```
Rubriblast
Prorubricyte
Rubricyte
Metarubricyte
Erythrocyte
```
143
What does Mycoplasma haemofelis appear like on the RBCs?
rod shaped on the periphery of the erythrocyte or as a basophilic ring on the cell
144
what does Cytauzoon felis appear on the RBC?
A ring and contains a small basophilic nucleus
145
What does Mycoplasma haemocanis appear like on the RBC?
small dots that chain across the surface of the RBC
146
What RBC morphology occurs because of Mycoplasma haemocanis?
Spherocytes because of the immune mediated anemia
147
What are the two stages of Cytauxzoon felis?
```
RBC stage
Tissue stage (macrophages)
```
148
What does Babesia canis appear like on staining?
a teardrop shaped structure
149
What does Babesia gibsoni appear like on staining?
small pale ring shape
150
What does Anaplasma appear like on staining?
A purple dot on the periphery of the RBC
151
What is Rouleaux formation and what causes it?
"coin stacking" of RBCs
Normal in the horse
Associated with increased globulin in small animals
Suggests antibody attachment to RBCs (IMHA)
152
What diseases are associated with Roulaeux formation in small animals?
Chronic Ehrlichiosis
| FIP
153
What can differentiate between agglutination and rouleaux formation?
A drop of saline
154
What is associated with agglutination?
Hemolytic anemia
155
What are three causes of anemia?
```
Increased loss (hemorrhage)
Increased destruction (Hemolysis)
decreased production
```
156
What are the clinical signs of anemia?
```
Pale mucous membranes
Lethargy, reduced exercise tolerance
Increased respiratory rate, dyspnea
Increased heart rate
Murmurs
```
157
What are the clinical signs associated with blood destruction?
Splenomegaly
Icterus (Jaundice)
Hemoglobinuria
158
What other laboratory tests can we run for anemia?
Serum Iron
Coombs test
Biochemical profile
159
What disease is the Coomb's Test associated with?
IMHA - Immune mediated hemolytic anemia
160
What are the indication of regenerative anemia?
Increased polychromasia
| Increased reticulocyte concentration
161
What are the two types of Blood destruction?
Intrinsic (Primary -Hereditary defects)
| Extrinsic (Secondary - parasites or immune mediated destruction)
162
What happens if there is blood loss into the body such as the abdomen?
Components of the blood can be reabsorbed
163
What happens if there is blood loss outside of the body such as the GI tract?
Components of the blood are lost and NOT reabsorbed
164
What happens to the PCV and TP with acute blood loss?
Decreased due to dilution with interstitial fluid
165
What types of RBC morphology are seen with Hemangiosarcoma?
Acanthocytes
| Schistocytes
166
What is the result of chronic blood loss?
Iron deficiency anemia
167
List some examples of Acute blood loss
Trauma & Surgery
Coagualation disorders
Bleeding tumors
Thromboocytopenia
168
List some examples of Chronic Blood loss
GI Ulcer
Bleeding GI tumor
Blood consuming parasites
169
What life stage of animals are naturally iron deficient?
Nursing animals
170
What is a differential diagnosis for microcytosis?
Portosystemic shunts
171
What kind of anemia do animals with anemia of inflammatory disease have?
normocytic anemia
172
What are the lab findings for iron deficiency anemia?
```
Microcytosis
Reticulocytes
Decreased MCV
Increased RDW
Normal MCHC
Thrombocytosis
Decreased serum iron concentration
Decreased transferrin saturation
```
173
What are the two types of Blood destruction?
Intravascular hemolysis
| Extravascular hemolysis
174
List examples of blood destruction
Immune mediated hemeolytic anemia
Heinz body anemia
RBC parasites
175
Clinical Signs associated with blood destruction anemia
```
Splenomegaly
Hyperbilirubinemia
Icterus
Hemoglobinuria
Hemoglobinermia
```
176
What are the laboratory findings for IMHA?
Thrombocytopenia
Inflammatory Leukogram
Sometimes Azotemic
177
List the characteristics of IMHA
```
Regenerative
Spherocytosis
agglutination
neutrophilia with left shift
thrombocytopenia
```
178
Neonatal Isoerythrolysis
Maternal antibodies against the neonates blood group antigen attach to the neonates RBCs with subsequent hemolysis
179
What are the clinical signs of Neonatal Isoerythrolysis?
```
Hemoglobinemia
Hemoglobinuria
splenomegaly
hepatomegaly
thrombocytopenia
DIC
```
180
What two parasites cause intravascular hemolysis?
Babesia
| Theileria
181
What are the clinical signs for M. haemofelis?
```
Same as Anemia
Splenomegaly
Fever
Lethargy
Icterus
```
182
What kind of transmission is commone with M. wenyonii in cattle?
Iatrogenic transmission
183
Does M. wenyonii always cause anemia in Cattle?
NO!
| unless they are splenectomized or immunosuppressed
184
Piroplasmosis in horses
Babesiosis
185
What is the stage of Theileria that resides within RBCs?
Piroplasm
186
Methemoglobin
a form of hemoglobin cannot carry oxygen due to Iron in ferric state
187
What color does blood appear when 30% of hemoglobin is methemoglobin?
Chocolate Brown
188
What causes Methemoglobin formation?
Acetaminophen toxicity in cats
Nitrate poisoning in cows
Red maple leaf ingestion in horses
congenital deficiency of NADH methemoglobin reductase
189
What two species of bacteria cause hemolytic anemia?
Clostridium
| Leptospira
190
"yellow lamb disease"
Clostridium perfringens Type A in lambs and calves
191
Pyruvate kinase deficiency
impaired energy metabolism (decreaased glucose utilization and ATP formation) with increased RBC destruction
192
Phosphofructokinase deficency
Hemolytic crisis when they become metabolically or respiratory alkalemic
193
Prophyria - "Pink tooth"
deficiency of uroporphyringen III co-synthetase - inability to synthesize hemoglobin with accumulation of uroporphyrin and coproporphyrin in bones and teeth
194
Clinical signs of Porphyria
Pink teeth
| Photosensitivity
195
What are two ways to tell if anemia is regenerative?
Based on the number of circulating immature erythrocytes (Polychromatophilic erythrocytes or reticulocytes)
196
What is another term for general bone marrow suppression?
aplastic anemia
197
What causes aplastic anemia?
```
Infectious agents (Ehrlichia)
Immune mediated destruction
Drugs and Chemicals
```
198
What are the infectious agents that cause aplastic anemia?
FeLV
Ehrlichia canis
EIA
199
What is immune mediated aplastic anemia?
Antibodies directed against stem cells in the bone marrow
200
Erythroid Aplasia
Pure red cells aplasia - immune mediated destruction of RBC precursors
RARE!
Ex: FeLV
201
Intrinsic causes of Erythroid hypoplasia
Myelodysplasia
Leukemia
Immune mediated destruction of erythroid precursors
202
Extrinsic causes of Erythroid hypoplasia
Chronic Renal Disease
Endocrine disorders
inflammatory disease
203
What is the cause of Anemia of chronic renal disease?
Lack of production of erythropoietin by the kidney
204
What is the cause of anemia of inflammatory disease?
Decreased iron in transport and functional pools, limiting iron for erythropoiesis
Possibly to reduce iron availability for bacterial growth
205
What two diseases are linked with Endocrinopathy-related Anemia?
Hypothyroidism
| Hypoadrenocorticism
206
List places to take a bone marrow aspirate in each species
Proximal end of the femur at the trochanteric fossa, Iliac crest, and Proximal humerus in dogs
trochanteric fossa and humerus in cats
Ilium, ribs and sternum in horses, cattle, and camelids
207
What are the two types of iron stores?
Ferritin and Hemosiderin
208
What is the iron store you can see on bone marrow aspirate?
Hemosiderin
209
What is the M:E ratio?
Number of granulocytes to nucleated erythrocytes
| Usually 1:1 up to 3:1 is normal
210
Why is there normally more granulocytes than erythrocytes in the M:E ratio?
Erythrocytes have a 120 day life span where granulocytes have a life span of 6-8 hours
211
What does an increased M:E ratio mean?
Erythroid hypoplasia/aplasia
Granulocytic hyperplasia
Granulocytic leukemia
212
What does a decreased M:E ratio mean?
Regenerative anemia
Erythroid leukemia
Lack of production of neutrophils
213
What is orderliness of maturation?
More of the cells present should be the more mature forms because one blast cell produces 16-32 mature cells.
