Transcript Document

Veterinary Hematology
-
An introduction
Gittan Gröndahl, DVM, PhD
What Is Blood, and
How Much Blood Is There?
B lo o d V o lu m e in A n im a ls in
% o f B o d y W e ig h t
Ho rse – w arm b lo o d
10 ,5
C attle – yo ung c alf
10 ,5
8 ,8
Do g
8 ,5
M o use
Ham ster
8 ,2
C attle – o ld er c alf
7,3
Guinea p ig
7,2
C at
7
M o nkey
6 ,7
Rat
6 ,7
Sheep
6 ,5
Ho rse – c o ld b lo o d
6 ,5
Go at
6 ,5
C attle – c o w
6 ,5
Pig
1
2
3
5 ,6
Rab b it
5 ,4
0
2
4
6
8
10
12
3
Red Blood Cells –
The Oxygen Carriers
Hemoglobin
Erythropoeisis:
rubriblast – prorubricyte –
basophilic rubricyte – polychromic rubricyte – normochromic
rubricyte – metarubricyte – reticulocyte –
mature erythrocyte
100 h
4
Red Blood Cells –
The Oxygen Carriers
Hypoxia
Erythropoeitin (EPO)
5
Red Blood Cells – Measurements
Hemoglobin
RBC
Hematocrit / PCV
6
Red Blood Cells –
Physiological Alterations
HGB
RBC
HCT
growing animals...
7
Red Blood Cells –
Physiological Alterations
exercise, fear, stress...
HGB
RBC
HCT

8
Red Blood Cells –
Physiological Alterations
dehydration, shock, high altitude, chronic lung disease,
anabolic steroids...
HGB
RBC
HCT

9
Red Blood Cells –
Physiological Alterations
anaemia, anaesthesia, sedation, late pregnancy...
HGB
RBC
HCT

10
Red Blood Cells –
Artefactual Alterations
hemolysis,
too little blood,
extended storage in EDTA...
HCT

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Red Blood Cells –
Regenerative Signs
Reticulocytes
Not normally seen in
horses, cattle, sheep, goats
0-2% in dogs and swine
2-4% in rat, mouse,
guinea pig, rabbit
0-5% in cats
If HCT <30% (dog) or <20% (cat)  count reticulocytes
12
Red Blood Cells –
Regenerative Signs
Reticulocytes –never in horses!
Not even seen in
regenerative anemia
in horses
Instead,
macrocytes
are released
RDW 
MCV 
13
Red Blood Cells –
Regenerative Signs
Nucleated RBC
Anisocytosis
greater variation in cell size, RDW 
Polychromasia
variable coloration
14
Red Blood Cells –
Regenerative Signs
Howell-Jolly bodies nuclear remnants
Basophilic punctuation
Macrocytosis
large cells, MCV 
15
So – What Is This?
African Gray Parrot RBC
Llama RBC
16
Red Blood Cells –
Number and size in mammals
17
Red Blood Cells –
Mean Cell Volume (MCV)
Used in classification of anemias:
Macrocytosis - MCV 
Often in regenerative anemia
Microcytosis - MCV 
Often sign of iron deficiency,
such as chronic blood loss
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Red Blood Cells – MCHC,
Mean Cell HGB Concentration
Used in classification of anemias:
Normochromic - MCHC normal
Hypochromic - MCHC 
In acute and chronic blood loss, hemolytic anemia or iron deficiency
(Hyperchromic - MCHC  )
Artefact!
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Blood Groups in Animals
All animals species have their
specific blood group system.
1. Blood transfusions
2. Incompatibility between dam and offspring
Cross-matching!
20
Anemia – Too Low Oxygen Carriage Capacity
Signs of anemia:
Pale in eye and mouth
Vigor and strength 
Appetite 
Heart rate 
Respiratory rate 
Laboured breath
Blood, bleedings, hematomas
Icterus
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Anemia – General Causes
1. Blood loss (regenerative anemia)
Coagulopathies
Gastrointestinal hemorrhage
Platelet disorders
Splenic rupture
Trauma/surgery
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Anemia – General Causes
2. Blood destruction / hemolysis (regenerative
anemia)
Fragmentation
Immune-mediated disease
Infections
Intrinsic RBC defects
Toxicities
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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
Important in inflammation and wound healing
cat
25
Platelets –
Thrombocytopenia – PLT 
Caused by:
Production 
Destruction 
Consumption 
dog
Signs,
if PLT <20-50 x 109/L:
Hematomas
Bleedings
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
27
Platelets –
Thrombocytopenia – PLT 
False Low PLT Caused by:
Platelet aggregates
Platelets and fibrin clumps
28
Platelets –
Thrombocytosis – PLT 
Caused by:
Surgery or trauma
Chronic bleedings
Acute/chronic infections or inflammatory
conditions
Cushing’s disease
Corticosteroid therapy
Myeloproliferative disorders
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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 proteins
Parasites
Allergic reactions
Antibodies
Cell destruction
Interplay
Phagocytosis
Allergic reactions
Histamin, heparin
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White Blood Cells –
Physiological Alterations
breed,
sex...
WBC
/ 
32
White Blood Cells –
Physiological Alterations
late pregnancy, feeding...
WBC

young animals...
exercise, stress, excitation...
33
White Blood Cells –
Artefactual Alterations
extended storage...
WBC

Cells from very sick animals
are the most sensitive
34
Granulocytes –
Neutrophils
White, small pink granules
White/pink,
no granules, ”knobby” nuclei
White,
no granules
White, small stronger
pink granules
35
Granulocytes –
Band Neutrophils
Bands = Left Shift
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
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Granulocytes –
Band Neutrophils
Bands = Left Shift
Degenerative left shift
Normal or Low WBC count with significant left shift
or
Band neutrophils ~ Segmented neutrophils
(with any WBC count)
37
Granulocytes –
Toxic Neutrophils
Segmented with
toxic change
Segmented, normal
Band with
toxic change
Band, normal
Basophilic discoloration, foaming,
Döhle bodies, toxic granules
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Granulocytes –
Eosinophils
Marked variation within and
between individual dogs
Small rod-shaped orange
granules
Very large globular orange
granules
Many small round orange
granules
Gray,
no granules, vacuoles
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Granulocytes –
Basophils
No granules,
ribbon-like nucleus, gray-lavender.
Rare.
Small deep purple granules.
Low numbers.
Small oval granules, pale
lavender. Rare.
Small deep purple granules.
Low numbers.
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Lymphocytes
Small, dense chromatin
Slightly larger
Small, dense chromatin
Quite variable
41
Lymphocytes -
Reactive and Granular
Reactive lymphocytes
Associated with immune
response
Larger,
coarse chromatin,
deep blue cytoplasm
Granular lymphocytes
Small pink granules
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Monocytes
Extremely variable in appearance in all animals
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Avian Hemogram
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Dogs’ Hemogram
Excitement (adrenaline =
epinephrine)
Stress (corticosteroids)
Not so much change
WBC 
All cells ()
Neutro 
No left shift
Lymph 
Inflammation
WBC 
Left shift
if >1 x 109/L bands
Neutro 
(10-30)
Eos 
Mono 
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Cats’ Hemogram
Excitement (adrenaline =
epinephrine)
Stress (corticosteroids)
Inflammation
Common reaction
WBC 
Lymph 
Neutro 
Left shift
if >1 x 109/L bands
No left shift
Neutro 
WBC  (25-40)
Lymph N/
Eos 
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Horses’ Hemogram
Excitement (adrenaline =
epinephrine)
Stress (corticosteroids)
Common reaction
WBC 
(-20)
WBC  (12-15)
No left shift
Lymph  (6-14)
Neutro 
No left shift
Lymph N/
Inflammation
WBC 
Left shift
if >0.3 x109/L bands
Neutro  (10-20)
Severe infections:
WBC ; Neutro ;
degenerative left shift; toxic
changes
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Cattles’ Hemogram
Normally: Lymph# > Neutro#
so WBC DIFF is more important than WBC#!
Excitement (adrenaline =
epinephrine)
WBC  (15-27)
No left shift
Lymph N
Stress (corticosteroids)
WBC N/
No left shift
Lymph 
Eos 
Inflammation
Acute:
WBC N/
Marked left shift (>0.3 x109/L
bands)
Chronic:
WBC  (20)
Neutro 
Left shift
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WBC-
General Interpretation
Repeated analyses ->
Best for assessment of
•
pathological conditions
•
duration
•
prognosis
49
WBC-
General Interpretation
•
neutrophils 
•
mild left shift
•
persistent eosinophils
Mild infection that the body can handle well
50
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
52
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
55
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
56
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-flag
Platelets and Red blood cells/Erythrocytes (RBC)
White blood cells / Leukocytes (WBC)
divided into 3 populations –
LYM, MID and GRAN
58
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
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Interpretation –
Numerical values
Referenc e interval
PLT
M PV
PCT
PDW
HGB
HCT
RBC
M CV
M CHC
RDW
281
12
0 .3 4
16
78
2 3 .4
3 .1
75 .5
332
14 .2
9
10 /L
200-500
fL
6 .1- 10 .1
H
%
g/L
Referenc e interval
L
12 0 - 18 0
3 7- 5 5
L
10 /L
5 .5 - 8 .5
L
fL
6 0 - 72
H
g /L
320-380
%
12 - 2 1
%
12
W BC
LYM
GRAN
M ID
15 .3
3 .5
9 .2
2 .6
10 /L
LYM %
GRAN%
M ID%
LM L/ G/ M
23
60
17
%
9
10 /L
9
10 /L
9
10 /L
Platelet count (PLT)
Mean platelet volume (MPV)
Plateletcrit (PCT)
Referenc e interval
9
Platelet parameters
6 ,0 - 17,0
1.2 - 5 .0
Platelet distribution width (PDW)
3 .5 - 12 .0
0 .3 - 1.5
H
%
%
60
Interpretation –
Numerical values
Referenc e interval
PLT
M PV
PCT
PDW
HGB
HCT
RBC
M CV
M CHC
RDW
281
12
0 .3 4
16
78
2 3 .4
3 .1
75 .5
332
14 .2
9
10 /L
200-500
fL
6 .1- 10 .1
H
Hemoglobin (HGB)
%
g/L
Referenc e interval
L
12 0 - 18 0
3 7- 5 5
L
10 /L
5 .5 - 8 .5
L
fL
6 0 - 72
H
g /L
320-380
%
12 - 2 1
%
12
W BC
LYM
GRAN
M ID
15 .3
3 .5
9 .2
2 .6
10 /L
LYM %
GRAN%
M ID%
LM L/ G/ M
23
60
17
%
9
10 /L
9
10 /L
9
10 /L
6 ,0 - 17,0
1.2 - 5 .0
Red blood cell count (RBC)
Mean cell hemoglobin concentration (MCHC = HGB/HCT)
Red cell distribution width (RDW)
3 .5 - 12 .0
0 .3 - 1.5
Hematocrit (HCT = RBC x MCV)
Mean red cell volume (MCV)
Referenc e interval
9
Red blood cell parameters
H
%
%
61
Interpretation –
Numerical values
Referenc e interval
PLT
M PV
PCT
PDW
HGB
HCT
RBC
M CV
M CHC
RDW
281
12
0 .3 4
16
78
2 3 .4
3 .1
75 .5
332
14 .2
9
10 /L
200-500
fL
6 .1- 10 .1
H
White blood cells count (WBC)
%
g/L
Referenc e interval
L
12 0 - 18 0
3 7- 5 5
L
10 /L
5 .5 - 8 .5
L
fL
6 0 - 72
H
g /L
320-380
%
12 - 2 1
%
12
White blood cell parameters
Lymphocytes (LYM, LYM%)
Granulocytes (GRAN, GRAN%)
Mid cells (MID, MID%)
Referenc e interval
9
W BC
LYM
GRAN
M ID
15 .3
3 .5
9 .2
2 .6
10 /L
LYM %
GRAN%
M ID%
LM L/ G/ M
23
60
17
%
9
10 /L
9
10 /L
9
10 /L
6 ,0 - 17,0
1.2 - 5 .0
3 .5 - 12 .0
0 .3 - 1.5
H
%
%
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Why review a blood smear?
To identify among the white blood cells for example…. To identify among the red blood cells for example….
Immature cells
Toxic changes
Monocytosis
Eosinophilia
Basophilia
Mast cells
Leukemia (blast cells)
Autoagglutination
Eccentrocytes
Echinocytes
Spherocytes
Heinz bodies
Nucleated red blood cells
Blood parasites in or on erythrocytes
Parasites 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
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