Lecture 4 - regeneration, RBC morphology, inclusions Flashcards by Jessica Buchy

never interpret data in raw __ form (uncorrected reticulocyte percent vs. absolute reticulocyte count)

percentage (wallet anology) - absolute numbers matter not percents!

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two methods to correct reticulocyte percent

calculate the absolute reticulocyte count (preferred)

2. calculate the corrected reticulocyte percent

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to calculate the absolute reticuloctye count (preferred) what do you need to know

total RBC count from automated analyzer

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To calculate the corrected reticulocyte percent what do you need to know

spun PCV %

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A dog has a PCV of 30%, a RBC count of 4,500,000 RBC/mcL and an uncorrected reticulocyte of 3%. What is the absolute reticulocyte count

RBC count x uncorrected % = absolute

4500000 x 0.03 = 135,000/mcL

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A dog has a PCV of 30%, a RBC count of 4,500,000 RBC/mcL and an uncorrected reticulocyte of 3%. What is the corrected reticulocyte percent?

“normal” PCV for dog = 45% (cats = 37%)

p PCV/”normal” PCV x uncorrected % = corrected %
30%/45% x 3% = 2%

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types of hemorrhage

external and internal, acute and chronic

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5 common causes of hemorrhaging

blood sucking parasites
GI or urogenital lesions
hemorrage into body cavities/tissues
trauma
hemostatic disorders

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__ hemorrhaging RBC, Iron, and blood proteins are LOST

External

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__ external hemorrhaging can cause so much iron to be lost that RBC production ceases, possibly leading to __

chronic, Fe deficiency nonregenerative anemia

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internal hemorrhaging RBC and blood proteins are not lost and __ is conserved

iron

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__ may occur from hemoabdomen or hemothorax internal hemorrhaging

autotransfusion

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Bleeding GI or UG lesions or blood sucking parasites are examples of __ hemorrhaging

external

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trauma is an example of __ hemorrhage

internal or external

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bleeding tumors of intra-abdominal or thoracic organs such as a splenic hemangiosarcoma is an example of __ hemorrhaging

internal

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some hemostatic disorders cause

internal or external hemorrhaging

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acute hemorrhage causes cells and fluid to be lost in equal amounts causing total blood volume in vasculature to __, what do you expect the inital PCV/TS to look like ?

decrease, at first PCV/TS will remain the same bc proportions are not changed. once fluid is replaced the PCV/TS will be low (only takes hours)

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3 protective responses to preserve O2 delivery during hemorrhaging

HR and BP rapidly increase
Splenic contraction (release RBCs)
interstitial fluid slowly moves from tissues to BV (dilutes remaining RBC and TP)

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__ and __ are classic findings after hemorrhaging

anemia and panhypoproteinemia

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interstitial fluid shift starts __ post hemorrhage and continues for __

3 hours, 2-3 days

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decreased PCV/TP occurs __ post hemorrhage

12-24 hours

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__ can increase PCV acutely and __ can increase PCV slowly

splenic contraction, autotransfusion

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normal PCV with low TP

GI protein loss, proteinuria, liver dz

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normal PCV with high TP

Increased globulin sythesis, dehydration masked anemia

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high PCV with low TP

Protein loss combined with relative or absolute erythrocytosis

high PCV with normal TP

splenic contraction, absolute erythrocytosis, dehydration masked hypoproteinemia

high PCV, high TP

Dehydration

low PCV low TP

Substantial ongoing or recent blood loss, overhydration

low PCV, normal TP

increased RBC destruction, decreased RBC production, chronic hemorrhage

low PCV, high TP

anemia of inflammatory dz, multiple myeloma, other lymphoproliferative dz

it takes __ for BM response to anemia to be seen in the blood

3 to 4 days, before this anemia may look non-regenreative

when does the peak response occur after hemorrhaging

1 week

Response to hemorrhaging in dogs and cats is __, cattle is __, and equids__

prominent, less dramatic (more basophilic stippling though), none visible (reticulocytes are not released from BM in equids)

horses do not release __ or exhibit __ but they do have __ to replace RBCs

reticulocytes, polychromasia, splenic contractions

__ in horses with hemorrhage can mask the anemia

splenic contractions

with RBC regeneration in horses you may see a mild increase in __ and mild increase in __

anisocytosis, MCV

how do you tell if horse with anemia is regenerative

measure PCV/TP every 2 days or do BM examination

5 acquired hemolysis

1. immune mediated 2. infectious 3. fragmentation 4. toxic 5. osmotic

3 congenital hemolysis (uncommon, will not talk about more)

1. glycolytic defects 2. membrane defects 3. hemoglobinopathies

__ triggers splenic macrophage removal of old RBCs

membrane damage

__ is death of RBCs

eryptosis

most of RBC are recycled in the liver: globin is broken down into __ and heme into __, __, __

``` globin = AA heme = CO, FE, unconjugated Bilirubin ```

liver metabolizes bilirubin which mostly

excreted (some is reabsorbed)

__ hemolytic anemia is more common, has rapid clinical course and many causes

acquired

__ is abnormal/pathologic increased rate of RBC destruction

hemolysis (reduces lifespan and causes anemia)

the severity of anemia and clinical signs for hemolysis depends on

how fast the RBCs are destroyed

slow/low grade hemolytic anemia will see

mild anemia but no clinical signs

rapid/severe hemolytic anemia will see

marked anemia and possible death

clinical signs of hemolytic anemia also are influenced by

predominant site RBC are destroyed

__hemolytic anemia, RBC are destroyed by macrophages in spleen and other organs (liver, LNs)

extravascular

__ hemolytic anemia, RBC are destroyed in the blood stream by several different mechanisms

intravascular

__ is abnormally rapid RBC death in NORMAL locations for RBC destruction, it can be acute or chronic and DIC is possible

extravascular

__ has a poor prognosis, abnormally rapid RBC death in ABNORMAL locations and is often __.

intravascular, rapid/acute

RBC death occurs in the __ not in an isolated environment causing circulatin fragments of damaged RBC to increase risk for __ and __

blood stream (intravascular), DIC and Anaphylactic shock

many cases of hemolysis are

mixed, but one usually predominates

key sign of intravascular hemolysis are __ in the plasma and __ in the urine

hemoglobinemia (free Hgb in blood) - causes plasma to be pink/red. hemoglobinuria - brown/red urine

due to rapid/severe intravascular hemolysis the __ become overwhelmed and cannot transport free Hgb to the liver for metabolism and recycling

Hgb transport protein

first sign of intravascular hemolysis is __ followed by __

hemoglobinemia (in plasma), hemoglobinuria (urine), when blood transport proteins are overwhelmed Hgt is passed in urine

Hgb from lysed RBC is metabolized into __ in the liver and is excreted in urine and feces (orange color)

bilirubin

__ is when excess bilirubin is passed in the urine and feces (can happen during hemolysis)

bilirubinuria

if bilirubin excretion and metabolism is backed up due t orapid/severe intravascular RBC death the will see biliruben in ___ and finally in the __

plasma = bilirubinemia, mucocutaneous tissue = icterus

can see clinical icterus with intravascular RBC death as the final location of bilirubin when concentrations are

greater than 2mg/dL

order of biliruben build up

urine (bilirubinuria) - plasma (bilirubinemia) - mucocutaneous tissue (icterus)

order of hgb build up

plasma (hemoglobinemia) - urine (hemoglobinuria)

where can icterus be seen first

back of soft palate (then sclera, vulva, abdomen, ear, gums)

why types of pigmentemia and pigmenturia can be seen with extravascular hemolysis

bilirubinuria, bilirubinemia, mucocutaneous icterus

what types of pigmentemia and pigmenturia can be seen with intravascular hemolysis

bilirubinuria, bilirubinemia, mucocutaneous icterus | hemoglobinemia, hemoglobinuria

what characteristic ddxs differentiates intravascular from extravascular hemolysis!

hemoglobinemia, hemoglobinuria (these are not present in extravascular hemolysis)

accumulation of pigments in urine, plasma, and tissues depends on the __ and __ of RBC destruction

rate and severity

animals with hemolytic dz __ exhibit pigmenturia, pigmentemia, or icterus

DO NOT always

bilirubinuria and bilirubinemia __ distinguish extravascular from intravascular hemolysis

DO NOT (hemoglobinemia/uria DO!)

__ means abnormal RBC shapes, these are possible changes with various causes to hemolysis

poikilocytosis

6 types poikilocytes (abnormal RBC shape)

1. acanthocytes (uneven spicules) - do not confuse with echinocytes/crenated cells 2. schistocytes (fragments) 3. Keratocytes 4. spherocytes (no central palar) 5. RBC ghosts 6. eccentrocytes and pyknocytes

abnormal RBC inclusions seen with various causes of hemolysis

1. heinz bodies (oxidative damage) | 2. infectious RBC parasites

Acanthocytes should not be confused with normally artifactual __

echinocytes/burr cells/crenated cells (even spicules) - this happens when blood sits in tube too long and ATP is depleted (can be pathologic too, ie envenomation)

__ can be seen with liver dz, fragmentation hemolysis, and tumors

acanthocytes

__ hemolysis occurs secondary to other dz (mechanical, endothelial, thermal injury)

fragmentation

4 mechanical causes for fragmentation hemolysis

1. DIC 2. Caval syndrom due to heartworms 3. glomerulonephritis 4. cardiac valve stenosis

3 endothelial injuries that cause fragmentation hemolysis

1. hemangiosarcoma 2. vasculitis 3. splenic or hepatic dz

what kind of thermal injury can cause fragmentation hemolysis

heat stroke and severe burns

common cause in dogs for fragmentation hemolysis is due to secondary dz

DIC

__ are seen in fragmentation hemolysis and DIC

Schistocytes and keratocytes

__ are seen in immune mediated hemolytic anemia (ON EXAM)

Spherocytes (perfectly round with no central palar, microcytic)

__ are coated with immune bodies and macrophages take a bite out of cell causing it to be smaller and Hb to be evenly distributed throughout the cell leaving a dark, no central palar cell

spherocytes (extravascular)

__ cells are seen with intravascular immune lysis (EXAM)

ghost cells (formed in the BV, macrophage undergoes complement mediated lysis of RBC "punches holes")

__ are why you see hemaglobinemia/uria

ghost cells

__ are seen with oxidative damage to lipid membrane

eccentrocytes (part of cell is clear due to LIPID MEMBRANE oxidation, sticks together pushing hgb out of way)

3 targets for oxidative damage in RBC

1. lipid membrane (eccentrocytes) 2. heme molecule 3. globin portion

__ are seen with oxidative damage to the globin molecule

heinz bodies

__ is a infectious epicellular RBC parasite that can be confused for basophilic stippling (rem cats don't really get basophilic stippling)

mycoplasma haemofelis

cytauxzoon, babesia, distemper, and mycoplasma are all

RBC inclusions (can cause hemolysis)

macrocytic hypochromic anemia with normal plasma color and regeneration. There are poikilocytes (schistocytes and acanthocytes) on the blood film. what is the cause?

hemorrhage (bc plasma is normal so hemolysis is less likely) and fragmentation hemolysis with possible DIC

thrombocytopenia, prolonged clotting factors, and schistocytes are signs of

DIC