Veterinary Hematology - An introduction Gittan Gröndahl, DVM, PhD.
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Transcript of Veterinary Hematology - An introduction Gittan Gröndahl, DVM, PhD.
Veterinary Hematology- An introduction
Gittan Gröndahl, DVM, PhD
3
B lo o d V o lum e in A n im a ls in % o f B o d y W e ig h t
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0 2 4 6 8 10 12
Rabbit
P ig
C attle – cow
Goat
Horse – co ldblood
Sheep
Rat
M onkey
C at
Guinea pig
C attle – o lder calf
Hamster
M ouse
Dog
C attle – young calf
Horse – w armblood
What Is Blood, and How Much Blood Is There?
1
2 3
4
Red Blood Cells – The Oxygen Carriers
Hemoglobin
Erythropoeisis:rubriblast – prorubricyte – basophilic rubricyte – polychromic rubricyte – normochromic rubricyte – metarubricyte – reticulocyte – mature erythrocyte
100 h100 h
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Red Blood Cells – The Oxygen Carriers
Erythropoeitin (EPO)
Hypoxia
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Red Blood Cells – Measurements
Hematocrit / PCV
RBC
Hemoglobin
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Red Blood Cells – Physiological Alterations
HGBRBCHCT
growing animals...
8
Red Blood Cells – Physiological Alterations
HGBRBCHCT
exercise, fear, stress...
9
Red Blood Cells – Physiological Alterations
HGBRBCHCT
dehydration, shock, high altitude, chronic lung disease, anabolic steroids...
10
Red Blood Cells – Physiological Alterations
HGBRBCHCT
anaemia, anaesthesia, sedation, late pregnancy...
11
Red Blood Cells – Artefactual Alterations
HCT
hemolysis, too little blood,
extended storage in EDTA...
12
Red Blood Cells – Regenerative Signs
Reticulocytes
If HCT <30% (dog) or <20% (cat) count reticulocytes
Not normally seen in horses, cattle, sheep, goats
0-5% in cats
2-4% in rat, mouse, guinea pig, rabbit
0-2% in dogs and swine
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Red Blood Cells – Regenerative Signs
Not even seen in regenerative anemia
in horses
Instead, macrocytes are released
RDW MCV
Reticulocytes –never in horses!
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Red Blood Cells – Regenerative Signs
Nucleated RBC
Polychromasia variable coloration
Anisocytosis greater variation in cell size, RDW
15
Red Blood Cells – Regenerative Signs
Howell-Jolly bodies nuclear remnants
Basophilic punctuation
Macrocytosislarge cells, MCV
16
So – What Is This?
African Gray Parrot RBC
Llama RBC
17
Red Blood Cells – Number and size in mammals
18
Red Blood Cells – Mean Cell Volume (MCV)
Macrocytosis - MCV Often in regenerative anemia
Microcytosis - MCV Often sign of iron deficiency,
such as chronic blood loss
Used in classification of anemias:
19
Red Blood Cells – MCHC, Mean Cell HGB Concentration
(Hyperchromic - MCHC )Artefact!
Hypochromic - MCHC In acute and chronic blood loss,
hemolytic anemia or iron deficiency
Normochromic - MCHC normal
Used in classification of anemias:
20
Blood Groups in Animals
All animals species have their specific blood group system.
Cross-matching!
1. Blood transfusions
2. Incompatibility between dam and offspring
21
Anemia – Too Low Oxygen Carriage Capacity
Signs of anemia:
Pale in eye and mouthVigor and strength
Appetite Heart rate
Respiratory rate Laboured breath
Blood, bleedings, hematomas
Icterus
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1. Blood loss (regenerative anemia)
Coagulopathies
Gastrointestinal hemorrhage
Platelet disorders
Splenic rupture
Trauma/surgery
Anemia – General Causes
23
Anemia – General Causes
2. Blood destruction / hemolysis (regenerative
anemia)
Fragmentation
Immune-mediated disease
Infections
Intrinsic RBC defects
Toxicities
24
Anemia – General Causes
3. Decreased / ineffective production of RBC
(non-regenerative anemia)
Anemia of inflammatory disease
Aplastic or hypoplastic anemias
Metabolic or endocrine disease
Neoplastic disease
Nutritional deficiency anemias (e.g., iron, copper, folate, cobalt)
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Platelets – The Sealers and Healers
First line of defense in damage to vessels
cow
cat
Important in inflammation and wound healing
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Platelets – Thrombocytopenia – PLT
Production Destruction
Consumption
Caused by:
Signs, if PLT <20-50 x 109/L:
HematomasBleedings
dog
horse
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Platelets – Thrombocytopenia – PLT
Certain medications
(antibiotics, NSAID,
hormones)
Some infections (FIV, FeLV,
BVDV, EIA, Ehrlichia etc)
Hemolytic anemia
DIC – Disseminated
intravascular coagulation
Vaccination
Malignant cells
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Platelets – Thrombocytopenia – PLT
Platelet aggregates
False Low PLT Caused by:
Platelets and fibrin clumps
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Platelets – Thrombocytosis – PLT
Surgery or trauma
Chronic bleedingsAcute/chronic infections or inflammatory
conditions
Cushing’s disease
Corticosteroid therapy
Myeloproliferative
disorders
Caused by:
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White Blood Cells – The defence troops
Defence
Cleaning up
Inflammatory reactions
Signalling system:
Cytokines
Receptors
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White Blood Cells – The defence troops
First line of defence
Phagocytosis
Toxic proteinsParasites
Allergic reactions
Allergic reactionsHistamin,
heparin
InterplayPhagocytosis
AntibodiesCell destruction
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White Blood Cells – Physiological Alterations
breed,
sex...
WBC/
33
White Blood Cells – Physiological Alterations
exercise, stress,
excitation...
young animals.
..
late pregnancy, feeding...
WBC
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White Blood Cells – Artefactual Alterations
WBC
extended storage...
Cells from very sick Cells from very sick animals animals
are the most sensitiveare the most sensitive
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Granulocytes – Neutrophils
White, small pink granules
White/pink, no granules,
”knobby” nuclei
White, small stronger pink granules
White, no granules
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Granulocytes – Band Neutrophils
Regenerative left shift
Neutrophilia with >1,0 x 109/L of Bands for dogs and cats
>0,3 x 109/ L of Bands for horses and cattle
Bands = Left Shift
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Granulocytes – Band Neutrophils
Degenerative left shift
Normal or Low WBC count with significant left shift
or Band neutrophils ~ Segmented neutrophils
(with any WBC count)
Bands = Left Shift
Poor
Prognosis!
38
Granulocytes – Toxic Neutrophils
Segmented, normal
Segmented with toxic change
Band, normalBand with toxic change
Basophilic discoloration, foaming, Döhle bodies, toxic granules
Guarded
Prognosis!
39
Granulocytes – Eosinophils
Very large globular orange
granules
Small rod-shaped orange granules
Many small round orange granules
Marked variation within and between
individual dogs
Gray, no granules, vacuoles
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Granulocytes – Basophils
Small deep purple granules.
Low numbers.
Small oval granules, pale lavender. Rare.
No granules, ribbon-like nucleus,
gray-lavender. Rare.
Small deep purple granules. Low numbers.
41
Lymphocytes
Slightly larger
Small, dense chromatin
Small, dense chromatin
Quite variable
42
Lymphocytes -Reactive and Granular
Larger, coarse chromatin, deep blue cytoplasm
Associated with immune response
Small pink granules
Reactive lymphocytes
Granular lymphocytes
43
Monocytes
Extremely variable in appearance in all animals
44
Avian Hemogram
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Dogs’ Hemogram
Stress (cortico-steroids)
WBC
Neutro
No left shift
Lymph
Eos
Mono
Excitement (adrenaline = epinephrine)
Not so much change
All cells ()
Inflammation
WBC
Left shift if >1 x 109/L bands
Neutro (10-30)
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Cats’ Hemogram
Stress (cortico-steroids)
WBC
Neutro
No left shift
Lymph N/
Eos
Excitement (adrenaline = epinephrine)
Common reaction
Lymph
Inflammation
WBC (25-40)
Left shift if >1 x 109/L bands
Neutro
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Horses’ Hemogram
Stress (cortico-steroids)
WBC (-20)
Neutro
No left shift
Lymph N/
Excitement (adrenaline = epinephrine)
Common reaction
WBC (12-15)
No left shift
Lymph (6-14)
Inflammation
WBC
Left shift if >0.3 x109/L bands
Neutro (10-20)
Severe infections:WBC ; Neutro ; degenerative left shift; toxic changes
48
Cattles’ Hemogram
Stress (cortico-steroids)
WBC N/No left shift
Lymph Eos
Excitement (adrenaline = epinephrine)WBC (15-27)No left shiftLymph N
Inflammation
Acute:
WBC N/Marked left shift
(>0.3 x109/L bands)
Chronic:
WBC (20)
Neutro Left shift
Normally: Lymph# > Neutro#
so WBC DIFF is more important than WBC#!
49
WBC- General Interpretation
•pathological conditions
•duration
•prognosis
Repeated analyses ->
Best for assessment of
50
WBC- General Interpretation
•neutrophils
•mild left shift
•persistent eosinophils
Mild infection that the body can handle well
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WBC- General Interpretation
•neutrophils
•mild left shift
•lymphocytes
•eosinopenia
Moderate or severe infection
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WBC- General Interpretation
•immature neutrophils
•segmented neutrophils
Grave condition
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WBC- General Interpretation
•neutrophils
•no immature neutrophils
•lymphocytes
•eosinophils
Stress (e.g., severe disease, pain) or steroid influence
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WBC- General Interpretation
•monocytes
Chronic disease
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WBC- General Interpretation
•degenerative left shift
•falling lymphocyte numbers
•persistent lymphopenia
•persistent absence of eosinophils
Each of these signs = Unfavourable prognosis
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WBC- General Interpretation
•falling WBC count together with increase in lymphocyte and eosinophil
counts
•decreasing numbers of immature neutrophils
Each of these signs = Good prognostic signs,
convalescence
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Interpretation – Medonic histogram (dog)
Platelets/Thrombocytes (PLT)
Platelets and Red blood cells / Erythrocytes (RBC)
White blood cells/Leukocytes (WBC) divided into 3 populations – LYM, MID and GRAN
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Interpretation – Medonic histogram (cat)
Platelets/Thrombocytes (PLT) – typical for cat: low, flat curve with poor distinction from red cells = FD-flagPlatelets and Red blood cells/Erythrocytes (RBC)
White blood cells / Leukocytes (WBC) divided into 3 populations – LYM, MID and GRAN
59
Interpretation – Medonic histogram (horse)
Platelets/Thrombocytes (PLT) – typical for horse: low, flat curve, relatively few platelets
Platelets and Red blood cells / Erythrocytes (RBC)
White blood cells / Leukocytes (WBC) divided into 3 populations – LYM, MID and GRAN
60
Interpretation – Numerical values
Platelet parametersPlatelet count (PLT)
Mean platelet volume (MPV)
Plateletcrit (PCT)
Platelet distribution width (PDW)
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Interpretation – Numerical values
Red blood cell parametersHemoglobin (HGB)
Hematocrit (HCT = RBC x MCV)
Red blood cell count (RBC)
Mean red cell volume (MCV)
Mean cell hemoglobin concentration (MCHC = HGB/HCT)
Red cell distribution width (RDW)
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Interpretation – Numerical values
White blood cell parametersWhite blood cells count (WBC)
Lymphocytes (LYM, LYM%)
Granulocytes (GRAN, GRAN%)
Mid cells (MID, MID%)
63
Why review a blood smear?
To identify among the white blood cells for example….Immature cellsToxic changesMonocytosisEosinophiliaBasophiliaMast cellsLeukemia (blast cells)
To identify among the red blood cells for example….AutoagglutinationEccentrocytesEchinocytesSpherocytesHeinz bodiesNucleated red blood cellsBlood parasites in or on erythrocytesParasites in plasma, e.g. microfilaria
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When should one review a blood smear?
If you routinely make a blood smear it will always be available ……
Blood samples that look very abnormal If WBC is lower or higher than normal,
especially if over 30x109/L If the absolute count of lymphocytes (LYM)
or mid cells (MID) is above normal If any parameter is outside normal range
together with an instrument flag Blood samples with signs of anemia