Lab 6 - WBC Flashcards

Question

**Haematological analysis of inflammatory processes** Where do you find the White blood cell (WBC) pools in the body:

Answer 1

1. In the **bone marrow**: - **mitotic**- (very young cells, proliferating), **- maturation**- (under differentiation) and - **storage- pools** (mature, differentiated WBCs). 2. In the **blood vessels:** - **marginal pool**, cells attached to the inner surface of the blood vessels (mostly **neutrophil granulocytes**), - Cells can be mobilized very quickly from this pool! 3. In the **circulating blood:** - we take our sample from here, - the **circulating pool**. - In the tissues of different organs: **tissue pool.**

Answer 2

Physiological leukocytosis develops due to **acute or chronic stress** (epinephrine, norepinephrine, glucocorticoids). 1. The effects of **catecholamines** are **visible within seconds** (neutrophilia, lymphocytosis- as cells are **mobilized from the marginal pool** /cells attached to the vessels, lymphatic vessels, and organs/). 2. The effects of **ACTH or glucocorticoids** can be detectable **after hours** (or in some instances minutes) (**neutrophilia, lymphopenia, eosinopenia**). 3. The older neutrophils are mobilized **from the bone marrow and marginal pools**, they do not die too early due to the **stabilisation of the lysosomal membranes**, meanwhile, there is a **severe lympholysis,** and the sequestration of lymphocytes to the lymphatic organs, eosinophil granulocytes are **NOT released** to the **circulation from the bone marrow.** In **cats, stress can cause extreme neutrophilia,** as the **marginal pool is bigger** (**2/3 of the total neutrophilic count) in cats.**

Answer 3

**Acute inflammation** The very first laboratory sign of inflammation is the: **1. increase of positive acute-phase proteins** (**APP**) in the **blood** and the **2. decrease of negative acute-phase proteins.** (see later in details)

Answer 4

1. During the **first period of the inflammatory process**, or **widespread severe inflammation** = NEUTROPENIA. 2. It is caused by the **migrating factors** (i.e**. leukotriens, interleukins** etc.) produced by tissue cells, **macrophages**. Neutrophils are **migrating out of the blood vessels to the site of inflammation** (into the tissues), and this can lead to a transient **decrease in the total WBC count.** We usually do not take blood samples in this very early phase of inflammation, that is why many people are convinced, that inflammation always causes a high WBC count!

Answer 5

**1. During later phases of inflammation = NEUTROPHILIA** occurs due to the **(G-CSF),** or **GM-CSF** produced by the **macrophages.** **2.** These **factors stimulate WBC production in the bone marrow**, which leads to an **increased total WBC count.**

Answer 6

**When More young WBCs appear in the circulating blood.** 1. **Young metamyelocytes (Jugend**), and 2. **Band (stab)** forms are visible in greater proportion and absolute number in the blood smear. First, cells are **mobilized from the marginal pool,** then **differentiated forms** are **migrating** from the **storage pool of the bone marrow.** **Later younger cells** enter the **bloodstream** from the **maturation pool of bone marrow**. In case of **severely increased tissue requirement** (or in neoplastic diseases i.e. acute myelogenous leukemia) **very young cells** (myelocytes, promyelocytes) **from the mitotic pool are going out.** **Two different types of left shifts!**

Answer 7

**Increased WBC count, neutrophilia, and left shift (younger neutrophils)**. After the first neutropenic phase, bone marrow regenerates the utilized neutrophils in the circulation by the younger cell population from the storage, maturation, and/or the mitotic pool. =This is the **most common cause of the appearance of young neutrophils**. **Regenerative left shift is a sign of a favorable prognosis.**

Answer 8

**Low, or normal WBC, and neutrophil count, and left shift (younger forms)**. **1.** If there is a **great neutrophil utilization in the tissues** (**widespread or very severe inflammation**, big **abscesses**, **peritonitis**, **pleuritis**, phlegmone, **pyometra**), and the **2. Rate of utilisation is bigger than the regenerative capacity of bone marrow**, = increased outflow of young neutrophils is **NOT enough to increase WBC count** (or even for the maintenance of normal WBC count!). **Degenerative left shift is a sign of poor prognosis, it means that the disease is very serious and needs immediate treatment.**

Answer 9

In some cases, when there is a **great stimulus for producing neutrophil granulocytes** in an enormous number **(WBC count can be \>70x10^9/l)** of **neutrophils can be present in the peripheral blood** due to **increased effects of G-CSF, GM-CSF**. This is a typical reaction in case of **big abscesses, endometritis (pyometra),** and in the case of some neoplastic **(but not leukaemia)** diseases. During blood smear analysis, a leukemoid reaction can be **easily confused with chronic myelogenous leukemia.**

Answer 10

In very **severe inflammatory processes** the **granulocytopoesis can be disturbed**. When the **granule production is NOT physiological**, some **azurophilic (orange-red) granules** can be seen in the **basophilic cytoplasm**. **These are “toxic” neutrophils,** or we can say that this **process is the toxic granulation of neutrophils**.

Answer 11

Due to **toxic effects** some **angular, basophilic inclusion bodies can be seen in some neutrophil granulocytes**. = These are the **remnants of the endoplasmatic reticulum.** **The appearance of Döhle- bodies is more common in cats.**

Answer 12

Right shift

Answer 13

Chronic inflammation Right shift: The right shift= **many segmented and hypersegmented, old neutrophils** (3-4 segments are on one nucleus) **are seen in the smear.** **The appearance of these older forms + increased WBC count = typical chronic inflammatory process**. This phenomenon is also typical for the **effects of glucocorticoids** (given as a therapeutic drug for different diseases, or increased production of endogenous glucocorticoids in the adrenal glands, **Cushing’s disease**). **Glucocorticoids inhibit cellular proliferation** (disappearance of young cells), and have membrane stabilizing effect (which let the neutrophils to grow old and become hypersegmented). Moreover, **glucocorticoids are lympholytic** and **inhibit the outflow of eosinophils from the bone marrow** (it can cause lymphopenia and eosinopenia). This is a common finding in the case of **MACROCYTOSIS of POODLES.**. **Right shift, leukocytosis, neutrophilia, lymphopenia**, and **eosinopenia** together is called a **stress leukogram.** Typical signs of **chronic inflammation** in the **CBC** are similar to the **glucocorticoid effect** (leukocytosis, neutrophilia, right shift), - the **difference** is that in this case **leukocytosis** is sometimes **associated with lymphocytosis**, **monocytosis**, and/or **eosinophilia**.

Answer 14

1. Haematology of **Addison’s disease (**hypoadrenocorticism): 2. **Pelger-Huet anomaly**: 3**. Cyclic neutropenia:** 4. **Bone marrow damage:**

Answer 15

There is **no inhibitory effect of glucocorticoids**, as there is **hypoplasia** or **necrosis of adrenal gland.** The typical changes are an **increase in WBC** (due to the **polyuria caused by increased PCV**), an **increase in young neutrophils, left shift** (no inhibition of cell proliferation), **lymphocytosis** and **eosinophilia**.

Answer 16

**= Normocytaemia, and left shift** (metamyelocytes, band forms of neutrophils) = I**nheritable problem causes diagnostic problem.**

Answer 17

This is an **inheritable disease of Grey Collies**. Due to **cyclic bone marrow activity**, = **Neutropenia occurs in weekly, monthly intervals**. **During these periods the animals are sensitive to infections.**

Answer 18

**Leukopenia** and **neutropenia** occur **in case of** **1. bone marrow damage** or **2. decreased bone marrow function.** **Thrombocytopenia** and **aplastic anemia** is often accompanied. When **other cells suppress the hemopoietic cells in bone marrow, it is called: MYELOPHTYSIS**

Answer 19

Description of Schilling-phases are found in the lecture notes

Answer 20

1. Glutaric aldehyde test 2. ESR - Erythrocyte Sedimentation Rate 3. CRP

Answer 21

Used to examine the **= increase of fibrinogen and globulin concentration in plasma**. - As **fibrinogen = acute-phase protein**, it can show a **marked increase during acute inflammatory** **processes**. This method is used in clinical practice to **indicate inflammatory processes in adult cattle** (more than one year old). 1. **Glutaric aldehyde solution causes rapid coagulation of fibrinogen and labile globulins**, so **blood** **mixed** with this **solution** can **show coagulation** within seconds **in case of an acute inflammatory process** (high fibrinogen and globulin level in the blood), **Even if the blood sample contains heparin or EDTA** (as an anticoagulant).. The **coagulation time** is **inversely** **correlated** to the **concentration of fibrinogen** and **globulins** in the blood. We generally use **heparinized blood and mix the sample** (i.e. 1-2 ml) with the same amount of 1,25% **glutaric aldehyde solution.** Tubes (or syringes) should be **checked for coagulation every 30 seconds** by turning them upside down. If the symptoms and the results are not correlated to each other, it is **necessary to repeat the test 24-48 hours later.** The test is primarily used to **diagnose RETICULOPERITONITIS,** **SEVERE MASTITIS or ENDOMETRITIS** in **cattle**. These animals can be extremely indolent, sometimes they show just **vague clinical signs**, (or no signs at all!!) **even if they are suffering from very severe diseases!**

Answer 22

1. **Coagulation time** 2. Presence of the **inflammatory proteins in the sample** 3. The **character** of the **pathological process**

Answer 23

Presence of the **inflammatory proteins in the sample** = **++++** The character of the **pathological** **process** = **Severe, widespread acute inflammation**

Answer 24

Presence of the inflammatory proteins in the sample= **+++** The character of the pathological process = **Acute inflammation**

Answer 25

Presence of the inflammatory proteins in the sample = **++** Character of the pathological process = **Subacute inflamation**

Answer 26

Presence of the inflammatory proteins in the sample= **+/-** Character of the pathological process= **Not severe inflammatory process**

Answer 27

Presence of the **inflammatory proteins in the sample** **= -** Character of the pathological process= There is **no inflammatory process**

Answer 28

The test is primarily used to **diagnose reticuloperitonitis, severe mastitis** or **endometritis** of cattle. - These animals can be extremely indolent, sometimes they show just vague clinical signs, (or no signs at all!!) even if they are suffering from very severe diseases!

Answer 29

= The **theory of ESR is the increased sedimentation of RBC**s due to **inflammatory processe**s, as the **acute phase proteins** and **other globulins** tend to attach to the **surface of RBCs**. **Normally** RBCs have **negatively charged albumin molecules on their surface** **= prevents RBC aggregation.** In case of **high globulin level in the blood** (severe inflammation or some types of neoplastic diseases can cause this), **= The surface of RBCs is covered by globulins, instead of albumins**. **Globulins have no negative** charge= **RBCs are able to attach to each other**, form big **aggregates and sediment quickly.** - **Increased globulin concentration causes increased ESR,** and this is generally due to **inflammatory or neoplastic processes**. **- Decreased albumin** concentration and as a consequence **relatively increased globulin concentration** causes **increased ESR**, too. (Note: in case of **chronic renal failure**, or **glomerulonephropathy** when there is **hypoalbuminemia ESR is typically increased**.)

Answer 30

**1. Specific tubes** (those made of glass are called: **Westergreen tubes** are used to perform this test. The tube contains **Na-citrate**, and there is a mm scale on it. The tube has a **hole on the bottom** (and on the top), so when it is **driven through the rubber plug** of another tube containing the blood sample, blood will flow up in the tube with the scale until the zero point. **The sedimentation rate of RBCs should be checked in the tube after one hour.** **2. Physiologically ESR is 0,5-3 cm/hour**. **3. ESR is inversely proportional with the Ht (PCV)**. 4. The sedimentation **can be biphasic** when the **young RBCs sediment later than the older forms.** **= This is common in case of immunhemolytic anemia** (regenerative anaemia, many young RBCs are produced). In this case, the older and even aggregated RBCs sediment much earlier than the younger forms. **5. Sedimentation is very fast in horses**, so **ESR must be evaluated after 20 minutes**. It is found that the **speed of the sedimentation decreases (!) due to inflammatory processes** contrary to other species. **6. ESR is inversely proportional with the Ht (PCV)**, and **proportional with the serum viscosity,** **total protein** and **fibrinogen concentration.**

Answer 31

10 = 79 15 = 64 20 = 49 25 = 36 30 = 26 35 = 16 40 = 10 45 = 5 50 = 0

Answer 32

10 = 86+-1 15 = 80+-1 20 = 70+-2 25 = 60+-3 30 = 47+-5 35 = 28+-15 40 = 11+-8 45 = 2,5+-1 50 = 0+-1

Answer 33

**C-reactive protein=CRP** (origin of the name of this acute-phase protein: it can bind non-specifically to a protein of **Pneumococcus bacteria,** called **protein-C, and cause precipitation)** In the case of **acute inflammatory processe**s the **concentration some of acute phase proteins becomes increased in the blood plasma.** **= Such acute phase protein is CRP, haptoglobin, serum amyloid A (SAA) etc.** **Some „negative” acute phase proteins** (i.e. **transferrin**, lactoferrin) show a **decreased concentration due to acute inflammatory process.** **CRP is produced in the liver** and in the **beginning** of the inflammatory process **cytokines** (interleukins) **stimulate its production.** For the **measurements of CRP we use serum samples**. The determination is based upon the immunological (**ELISA** or immunturbidimetric) method. **Today species (dog, horse) specific ELISA methods are available.** **General physiologial value: 8 mg/l** In the **beginning of the acute inflammatory process, CRP values are increased,** **before** the appearance of the **clinical signs.** (In case of concomitantly **decreased liver function** this increase might not be so marked.) Therefore it is a very **useful diagnostic tool for the early detection of inflammatory processes**. This can be **extremely important in immunosuppressed animals**, for example during **chemotherapy**, or **high dose glucocorticoid therapy**. = In these cases, the well-known clinical and laboratory signs of inflammation can be vague or absent!

Answer 34

The most common **leukemic types.** **1. Acute** leukemic diseases: **2. Chronic** leukemic diseases: **3. Lymphomas** are hemopoetic tumours, too.

Answer 35

**1., Acute leukemic diseases**: Typical cell types in these tumors are **„blast” cells,** that have coarse **chromatin pattern**, and **have nucleoli.** ## Footnote The **origin** of these cells can be **evaluated by (immune)cytochemical,** and **bone marrow analysis.** In some cases, **neoplastic cells do not appear in peripheric blood,** **- but anemia, leukopenia,** **thrombocytopenia.** In these cases bone marrow evaluation is important.  **Acute lymphoblastic leukemia**  **Acute myeloblastic,** promyelocytic leukemia ** Acute erythroblastic leukemia**  **Lymphoma of Stage V** (metastatisis to bone marrow)

Answer 36

**2. Chronic leukemic diseases:** Typical cell types in these tumors are **mature differentiated, or well differentiated cells**, that appear in **enormous numbers in the peripheric blood**. - This presentation does **NOT cause diagnostic difficulties** in the case of lymphoid, thrombocytes, or erythroid forms, but it can be mixed with a leukemoid reaction. In order to diagnose these diseases **bone marrow evaluation is essentially required.** ** Chronic small lymphocytic leukemia,** ** Chronic myeloid** (neutrophil granulocytic, eosinophil granulocytic, basophil granulocytic, monocytic leukemia) ** Polycythaemia absoluta vera** (overproduction of mature erythrocytes), ** Essential thrombocytosis** (overproduction of mature thrombocytes).

Answer 37

Lymphomas are **hemopoietic tumors**, too. In this disease, **poorly differentiated lymphoid cells are overproduced in lymphatic organs (lymph nodes, spleen)** and sometimes in other tissues **(liver, skin, intestines etc.).** In some cases, **tumorous lymphoid cells are overproduced in bone marrow, too**. The origin of this is **proved in the case of cats and cattle, only.** In these species, **viral infection is causing this disease** (Bovine Leukosis Virus /BVL/ és a Feline Leukemia Virus /FeLV/).

Answer 38

1. Erythrocytes 2. Leukocytes 3. Thrombocytes

Answer 39

* *WBC (leukocyte)** * *Sample anticoagulated blood** (Na2EDTA, K2EDTA, or Na-citrate) **Normal WBC count: 6-12x 10^9 (G/l) (G=giga)** **• Counting:** **1. Bürker-chamber method** **2. Estimated RBC-count** **3. Automated cell counters** • Evaluation of the blood-smear

Answer 40

● RBC morphology: **spherocytes**, **Heinz bodies, RBC parasites.** ● RBC **autoagglutination** ● **Thr.cyt aggregation** ● **Thr.cyt count & morphology** **● WBC differential count, morphology** **● Neutrophil: left shift, toxic change** **● Atypical cells / abnormal blast cells**

Answer 41

● May-Grünwald ● Romanowsky ● Giemsa ● Diff-Quick

Answer 42

● Myeloblast ● Promyelocyte ● Myelocyte ● Metamyelocyte (jugend) ● Band forms (stab) ● Segmented forms (Mobblast Prom Mye Metamye Band Segmented)

Answer 43

● 1,5-2x RBC size

Answer 44

● **Segmented** **nucleus** into **lobes** ● **Neutrophil**, or the **heterophil** (birds, reptiles and some mammals) granules in CP ● **Band neutrophils elongated, U‐shaped, non-lobulated nucleus**

Answer 45

● Bone marrow ● Blood ● Tissue

Answer 46

Neutrophilia 1● Left shift: a● Regenerative left shift: b● Degenerative left shift: 2● Right shift:

Answer 47

**1● Left shift: release of immature neutrophils (predominantly band forms) from the bone marrow.** a● **Regenerative** left shift: ● Neutrophilia in which **mature neutrophils exceed bands** ● **Good prognostic indicator** b● **Degenerative** left shift: ● **Low or normal Ne. gr. count** and band cells exceed mature neutrophils. **● Poor prognostic indicator** 2● Right shift: ● **Mature neutrophilia** ● **Hypersegmented** neutrophils have **five or more lobes in the nucleus**

Answer 48

Toxic neutrophils ● **Enhanced neutrophil turnover and reduced maturation time** ● **Severe inflammatory disease** (severe bacterial infections), **IMHA** ● Not necessarily associated with "toxemia” ● **Increased cytoplasmic basophilia,** **increased residual cytoplasmic RNA** ● Frothy or vacuolated cytoplasm, which represents degranulation of llysosomes ● Döhle bodies: these are grey-blue intracytoplasmic inclusions representing aggregates of cytoplasmic reticulum ● **Commonly found in normal cats** ● Can develop as an **artifact in stored samples**

Answer 49

Toxic neutrophil due to **SEVERE INFLAMMATION = IMHA** **Döhle bodies**: Normal in cat

Answer 50

1● **Physiological neutrophilia**: acute stress, **adrenaline release** (i.e. **cat blood sampling**) 2● **Stress**/steroid response: **● Hyperadrenocorticism**, Exogenous corticosteroids **● No left shift,** ● Stress Leukogram: monocytosis, lymphopenia and eosinopenia **3● Acute inflammatory response** ● **Bacterial infections, Immune-mediated disease,** Neoplasia, Tissue necrosis ● **Left shift** **● Toxic changes**

Answer 51

Neutropenia: 1● **Peracute bacterial infections** 2● **Retroviral infection** (FeLV,FIV), **Parvovirus** 3● **Bone marrow disorders:** aplastic anemia, **leukaemia**, neoplasia, myelofibrosis, myelodysplasia 4● **Cytotoxic myelosuppressive drugs**

Answer 52

Leukemoid reaction WBC count **\>70x10^9/l)** Extreme neutrophilia **\>50% neutrophils** **Marked left shift** Increased effects of **G-CSF, GM-CSF**

Answer 53

● Severe localized **pyogenic infection**s: **Pyometra**, Pyothorax, Peritonitis, **Abscess** ● **Neoplasia** ● **Tissue necrosis** ● Chronic Myelogenous Leukemia **(CML)**

Answer 54

**● Size ~ RBC** ● **Round nucleus** ● **Smooth, dense chromatin** ● Narrow rim of **basophilic cytoplasm** ● **Vary in size**

Answer 55

1● **Reactive lymphocytes** - immunocytes ● Larger, basophilic cytoplasm ● Reflect antigenic stimulation **2● Granular lymphocytes** ● Prominent pink cytoplasmic

Answer 56

• Lymphocytosis: 1. Physiological - catecholamines 2. Prolonged presence of antigen (vaccination) 3. Hypoadrenocorticism 4. Lymphoproliferative disorders

Answer 57

Lymphopenia: 1. **Lymphoprolipherative disorders** **2. Stress** leukogram **3. Glucocorticoids**, immunosuppressants, **chemotherapy** **4. Viral infection, sepsis**

Answer 58

Monocytes ● **Larger** than **neutrophils** ● Extreme variable shape, no consistent species differences ● Very variable **shape of the nucleus:** * *● Ameboid** * *● Bean-shaped** **● Band-like ● lobulated, ● U-shaped** ● **Cytoplasm:** - vacuoles, - granules, - slightly grainy

Answer 59

1● Acute/chronic inflammation 2● Tissue necrosis 3● Immune-mediated diseases 4● Stress, endogenous/exogenous steroid response 5● Stress Leukogram: **neutrophilia** (no left shift), **monocytosis**, **lymphopenia** and **eosinopenia** 6● **Monocytic** or **myelomonocytic leukemia**

Answer 60

● Slightly **larger than a neutrophil** ● **Segmented nucleus with 2-3 lobes** ● **Eosinophilic cytoplasmic granules** ● Marked **SPECIES VARIATION** 1● **Dog**: **granules are round**, size, numbers are very variable - **Greyhounds**: **grey cytoplasm**, and vacuolated appearance because their **granules do not stain** 2● **Cat:** small uniform, **rod**-shaped **orange-pink granules** 3● **Horse**: looks like a **rasberry**

Answer 61

**1● Parasitic** **2● Allergy** - Feline asthma (fe) - Eosinophilic bronchopneumopathy(ca) - Eosinophilic granuloma complex (fe) - Atopy, Food hypersensitivity **3● Inflammatory** - Eosinophilic enteritis (IBD) - Eosinophilic myositis **4● Hypereosinophilic syndrome** **5● Neoplastic Mast cell tumor** **6● Hypoadrenocorticism (ca)**

Answer 62

1● Stress leucogram 2● Glucocorticoids

Answer 63

● Mildly lobulated, ribbon-like nucleus ● Dark purplish cytoplasmic granules **● Canine**: **long**, folded nucleus; grey, **lavender cytoplasm** **● Feline:** **round** to **oval** granules, **pale lavender, to deep purple** **● Horse: deep purple granules**

Answer 64

**1● BASOPENIA** ● Corticosteroid **2● BASOPHILIA:** ● Allergy ● Parasites ● Mast cell neoplasia

Answer 65

● Extremely **sensitive markers of inflammation** ● Extremely **non-specific** ● The **decline in APP concentrations** may indicate a response to treatment ● **Triggered by proinflammatory cytokines:** **-** interleukin (IL)-1, IL-6 (produced by macrophages→ APPs production in hepatocytes **● Fibrinogen: in all species production is stimulated as part of the acute phase response** **1● Major APPs:** rapid increase (often within 24–48 hours) 5–50-fold **● Dog: C-reactive protein (CRP)** **● Cat: Serum amyloid A (SAA)** **2● Moderate APP**s: slower increase (within 4–7 days) 2–10-fold ● **Dog, cat**: Haptoglobin (Hp) **3**● **Negative APP**s: concentrations decline - Albumin, transferrin

Answer 66

MAJOR **- SAA** Moderate **- AGP** **- Hp** SAA: serum amyloid A, CRP: C-reactive protein, Hp: haptoglobin, AGP: α1 acid glycoprotein Method: ELISA or immunturbidimetric

Answer 67

MAJOR **- CRP** **- SAA** Moderate **- Hp** **- AGP** SAA: serum amyloid A, CRP: C-reactive protein, Hp: haptoglobin, AGP: α1 acid glycoprotein Method: ELISA or immunturbidimetric

Answer 68

MAJOR **- SAA** Moderate **- Hp** SAA: serum amyloid A, CRP: C-reactive protein, Hp: haptoglobin, AGP: α1 acid glycoprotein Method: ELISA or immunturbidimetric

Answer 69

MAJOR **- Hp** **- SAA** Moderate **- AGP** SAA: serum amyloid A, CRP: C-reactive protein, Hp: haptoglobin, AGP: α1 acid glycoprotein Method: ELISA or immunturbidimetric

Answer 70

MAJOR **- CRP** **- MAP** **- SAA** Moderate **- Hp** SAA: serum amyloid A, CRP: C-reactive protein, Hp: haptoglobin, AGP: α1 acid glycoprotein Method: ELISA or immunturbidimetric

Answer 71

● **Non-specific measure of inflammation** **1**● In normal conditions: - **RBCs are negatively charged due to albumin attached to the surfaces** and repel each other **2**● **In inflammatory conditions albumin↓, fibrinogen↑, globulins (positively charged)**: **APPs, immunglobulins↑** → RBC aggregation, **rouleaux formation**, **sedimentation↑** **3. Method:** ● Fresh Na-citrate (1:4) ● **Westergren** tubes ● Normal values Note: mm/h. = millimeters per hour. **● Eq: 20 min - ESR slower in inflammation**

Answer 72

● In **Adult cattle** ● **Fibrinogen as APPs markedly increases** during acute inflammatory processes **● “Point-of-care” test** ● **Fresh anti-coagulated (heparinized) whole blood** mixed with 1-2 ml **glutaric aldehyde solution** ● Rapid **coagulation of fibrinogen** and labile globulins ● Coagulation **within seconds in case of the acute inflammatory process** **● Diagnose** **- reticuloperitonitis,** **- severe mastitis,** **- endometritis**