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RBCs Flashcards

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1
Q

basophilic stippling

A

aggregates of ribosomes that are visualized as small basophilic granules within an RBC

most often seen in immature erythrocytes of ruminants

also seen in immature erthyrocytes of dogs and cats with highly regenerative anemias

lead poisoning

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2
Q

hemoglobin functions

A

transport O2 from lungs to tissues

transport CO2 from tissues to lungs

buffer hydrogen

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3
Q

Hgb physiology

A

iron in Hgb molecule must be in the reduced form to bind oxygen

when oxidized-called methemoglobin

too much methemoglobin-mucous membranes cyanotic and blood is brown

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4
Q

iron metabolism

A

absorbed from intestine-small % in health, during disease increased

transported in blood by transferrin

stored in tissues as hemosiderin or in plasma bound to ferritin

evaluation of iron content of body: serum iron, serum total iron-binding capacity, serum ferritin or bone marrow hemosiderin content

serum iron is low in iron deficiency but also low in conditions where tissue iron is normal or increased

serum ferritin best serum indicator of total body iron content

TIBC-measure of transferrin in blood

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5
Q

Erythrocyte lifespan

A

dog-120 days

cat-70 days

cow-160 days

horse-145 days

relatively long lived compared to other blood cells

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6
Q

destruction of RBCs

A

removed by macrophages which attached to RBC membrane

RBC lysed and hemoglobin degraded into heme and globin

Globin–>amino acids

Heme–>iron and bilirubin

bilirubin-released from macrophages into circulation where albumin binds it and transports it to the liver where it is conjugated and excreted in the bile

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7
Q

microcytic RBCs

A

iron deficiency anemia (chronic blood loss)-related to extra cell division as RBCs mature in marrow

Portosystemic shunts/liver failure-altered iron kinetics

specific breeds-akita, shiba dogs

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8
Q

macrocytic

A

significantly increased number of young RBCs in circulation

FeLV (no poly)

poodle macrocytosis (rare)

hereditary stomatocytosis

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9
Q

anisocytosis

A

variation in RBC size

RDW

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10
Q

hypochromic RBCs

A

associated with significantly increased numbers of reticulocytes in circulation

iron deficiency-Hgb synthesis is impaired

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11
Q

hyperchromic RBCs

A

almost always an artifact

can’t produce RBCs with too much Hgb

may be free Hgb in plasma (hemoglobinemia) or presence of interfering substances or structures (lipemia, icterus, Heinz bodies)

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12
Q

normal shape for dog

A

biconcave disk with central pallor

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13
Q

normal shape for cat, pig, horse, cow, sheep

A

discoid shape with little to no central pallor

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14
Q

normal shape for Llama, camle, bird, reptile

A

ellitical shape

bird & reptile-nucleated RBCs

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15
Q

poikilocyte

A

abnormall shapred RBC

may be present in healthy goats, pigs and young cattle

frequently seen in dogs and ruminants with iron deficiency

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16
Q

spherocyte

A

decreased diameter, decreased ccentral pallor, increased staining intensity

typically have relatively normal cell volumes

suggest immune mediated damage to RBCs

form from partial phagocytosis of RBC membranes by macrophages

associated with blood transfusion, bee sting and zinc toxicity

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17
Q

schistocyte

A

irregulatly shaped RBC fragment that occurs when RBCs are forced through altered vascular channels, vessels containing fibrin strands or exposed to turublent blood flow

associated wtih DIC, Hemangiosarcoma, vasculitis and +/- iron deficiency

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18
Q

keratocyte

A

RBC with blister or 2 “hornlike” projections

formed by intravascular trauma or iron deficiency

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19
Q

eccentrocyte

A

RBC with Hgb shifted to one side and a clear membrane bound area on the opposite side

form from oxidative damage to RBC membranes

may be seen with Heinz bodies

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20
Q

ghost cell

A

formed from lysis of RBCs

very pale staining cells consisting of an empty RBC membrane

artifactual or pathologic (IMHA, Heniz body hemolysis)

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21
Q

acanthocyte

A

RBC with irregularly spaced surface projections of variable length and diameter

result of altered lipid/cholesterol content of cellular membranes

associated wtih splenic hemangiosarcoma, liver disease, renal disease

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22
Q

Echinocyte

A

RBC with many short evenly spaced uniform surface projection

artifact-associated with blood film prep and slow drying

pathologic- eletrolyte depletion, renal disease, neoplasia, rattlesnake envenomation, chemotherapy

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23
Q

Codocyte

A

RBC that has excess membrane

“target cell”

central area of Hgb surrounded by clear ring and an outer rim of Hgb

associated with regenerative anemia in dogs, hepatic and renal dz

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24
Q

Heinz bodies

A

clumps of denatured Hgb that results from oxidative damage

Wright: appear small eccentric pale structures that often protrube from the cell margin

NMB: dense blue structures

RBCs more susceptible to intravascular and extravascular hemolysis

up to 10% normal in cats

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25
Howell-Jolly bodies
nuclear fragments retained within an RBC appear small round dark blue inclusions increased numbres may be seen in regenerative anemias, splenectomy or suppressed splenic function
26
Siderotic granules (pappenheimer bodies)
iron granules within mitochondria and lysosomes impaired Heme synthesis, myelodysplasia and ineffective erythropoiesis
27
nucleated erythrocytes
metarubricytes (metarubricytosis) never normal to see present due to toxic, hypoxic or physical damage to bone marrow endothelium associated with regenerative anemia should not be used as an indicator of RBC regeneration other r/o: lead poisoning, chemotherapeutic use, neoplasia or inflammation with marrow space and splenic contraction or dysfunction
28
Rouleaux
spontaenous association of RBCs in linera stacks normal in horses slight amount in cats and some dogs enhanced with increased plasma proteins
29
Agglutination
irregular spherical clumps of RBC grape like clusters caused by antibody bridging between RBCs DDx: IMHA
30
How to differentiate rouleaux from agglunation
small amount of blood and saline are mixed together rouleaux will disperse agglutination will stay the same
31
anemia
not a disease determine underlying cause decrease in HCT, [Hgb] or RBC count
32
bone marrow response to anemia
decreased circulating RBCs--\>hypoxmia Epo producing cells in renal cortex sense hypoxmia--\>increased production of Epo increase in Epo stimulates bone marrow to increase RBC production
33
when do reticulocytes appear in blood
within 2-3 days peak within 7 to 10 d
34
Reticulocytes
show up as RBCs with large blue mats of RNA and mitochondria when stained with New Methylene Blue stain
35
polychromasia
larger, pink/blue RBCs viewed on a Wright stained blood smear +1 poly can be normal in dog
36
reticulocyte count
indicative of regenerative anemia assessment of bone marrow response
37
horses and reticulocytes
they do not release reticulocytes into the peripheral circulation do serial CBCs or bone marrow biopsy
38
Patient history with anemia
duration of clinical signs (acute vs chronic), exposure to drugs, plants, chemicals, history of blood loss (hematuria, melena, epistaxis), parasite control, etc
39
physical exam of patient with anemia
icterus, bruisng, petechial or ecchymotic hemorrhages, cyanosis, mucus membrane color, hydration status, evidence of trauma, abdominal distention, etc
40
acute hemorrhage
HCT and plasma proteins concentration will not decrease until the plasma volume is replaced over the next 24 to 72 hours, fluid moves into circulation to re-establish blood loss HCT and plasma protein concentration will decrease internal or external
41
What is anemia of blood loss initiated characterized as?
normocytic, normochromic non-regenerative anemia
42
What can anemia of blood loss become?
macrocytic, hypochromic regenerative anemia increased number of reticulocytes
43
causes of blood loss
trauma coagulopathies surgical procedures parasites neoplasia
44
causes of iron deficiency anemia
mature animals: result of chronic blood loss neonates: poor iron intake and high growth rates
45
typical cbc findings for iron deficiency anemia
microcytic, normochromic or microcytic, hypochromic regenerative but in later stages show poor signs of regeneration hypoproteinemia Keratocytes, schistocytes, hypochromic RBCs Low serum ferritin and poor iron stores in bone marrow thrombocytosis
46
clinical intravascular hemolysis
within blood vessels or heart marked RBC damage marked or rapidly falling anemia occurs hours to days after insult reticulocytosis occurs are presentation Hemoglobinemia Hemoglobinuria +/- Hyperbilirubinemia +/-bilirubinuria
47
predominantly extravascular hemolysis
macrophages of spleen, liver and bone marrow mild to marked RBC damage mild to marked anemia occurs over days to weeks reticulocytosis at initial presentation hyperbilirubinemia bilirubinuria
48
haptoglobin
in circulation binds free Hgb taken up by hepatocytes when bound to Hgb causes pink to red color in plasma
49
Immune mediated hemolytic anemia
typically regenerative normocytic, normochromic or macrocytic, hypochromic spherocytes Positive Coombs' test agglutination inflammatory leukogram +/-hemoglobinemia/hemoglobinuria
50
Mycoplasma haemofelis
small blue rod or ring forms on the surface of RBCs spread through infected blood via blood feeding arthropods also spread from queen to kittens
51
mycoplasma haemocanis
small chains of cocci that may branch usually only causes disase in immunosuppressed dogs or splenectomized animals
52
Mycoplasma wenyonii (cattle) Mycoplasmas ovis (sheep, goats) Mycoplasma haemolamae (llamas, alpacas)
small basophilic structures on RBCs or sometimes free in the background
53
Anaplasmosis
Rickettsial organism larger than Mycoplasma but smaller than Howell Jolly bodies usually around basophilic structures transmitted by ticks, biting flies and iatrogenically hemolytic anemia in cattle sheep and goats
54
Babesiosis
Causes hemolytic anemia Babesia canis & B. gibsoni (dog) B. equi (horse) B. bigemina (ruminants) piriform transmitted by tick, direct blood contamination
55
Theileriosis
56
Cytauxzoonosis
57
Feline Heinz body anemia DDx
acetaminophen onion/garlic propylene glycol zinc toxicity methylene blue propofol DM Hepatic lipidosis hyperthyroidism hymphosacroma
58
canine heinz body anemia DDx
onion/garlic acetaminophen zinc toxicity propylene glycol propofol benzocaine naphthalene
59
Equine heinz body anemia DDx
red maple leaf ingestion onion/garlic
60
ruminant heinz body anemia DDx
Brassica sp (kale, rape, cabbage) onion/garlic copper toxicosis selenium deficiency
61
Fragmentation Anemia
results from direct physical trauma to RBCs caused by DIC, vasculitis, vascular tumors, etc increased schistocytes and keratocytes
62
DDx for nonregenerative anemia
Anemia of inflammation (chronic disease) Anemia of chronic renal failure pure red cell aplasia aplastic pancytopenia bone marrow replacement
63
Anemia of Inflammation Anemia of chronic disease
common mild to moderate anemia develops over days to weeks then stabilizes resolves with correction of underlying cause normocytic, normochromic non-regenerative
64
Anemia of inflammation pathophysiology
complex and multifactorial altered iron kinetics decreased EPO production decreased marrow response to Epo decreased RBC life span
65
Anemia of CKD
moderate to severe normocytic, normochromic non-regenerative result of decreased Epo production correlates wtih severity of CKD
66
Pure red cell aplasia
severe normocytic, normochromic non-regenerative anemia normal leukocyte and platelet numbers marked decrease in erythroid precursors in bone marrow with normal granulocytic precursors and megakaryocytes caused by immune mediated destruction of erythroid precursors in bone marrow occ. spherocytes direct Coombs' test infrequently positive
67
Aplastic pancytopenia
biocytopenia bone marrow space is replaced by fat normocytic, normochromic non-regenerative anemia caused by reversible or irreversible damage to hematopoietic precursors in bone marrow drugs, toxins, estrogen, infectious agents (parvovirus, FeLV, Ehrlichia canis)
68
bone marrow replacement
one or more cytopenia neoplasia & myelofibrosis
69
Erythrocytosis
aka polycythemia increased concentration of RBCs in circulation increased HCT, RBC count and [Hgb]
70
Relative erythrocytosis
loss of body fluid splenic conctraction (epinephrine leukogram)
71
absolute erythrocytosis
primary-polycythemia vera-rare chronic myeloproliferative disorder secondary appropriate-systemic hypoxemia due to lung dz, cardiac dz or high altitudes; results in increased Epo production secondary inapproriate-renal ischemia or erythropoietin producing tumor
72

clinical pathology (8 decks)

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