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Veterinary Hematology

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Veterinary Hematology - An introduction Gittan Gr ndahl, DVM, PhD What Is Blood, and How Much Blood Is There? What Is Blood, and How Much Blood Is There? – PowerPoint PPT presentation

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Title: Veterinary Hematology


1
Veterinary Hematology
  • - An introduction

Gittan Gröndahl, DVM, PhD
2
What Is Blood, and How Much Blood Is There?
3
What Is Blood, and How Much Blood Is There?
4
Red Blood Cells The Oxygen Carriers
Hemoglobin
5
Red Blood Cells The Oxygen Carriers
Hypoxia
Erythropoeitin (EPO)
6
Red Blood Cells Measurements
Hemoglobin
Hematocrit / PCV
7
Red Blood Cells Physiological Alterations
HGB RBC HCT
growing animals...
8
Red Blood Cells Physiological Alterations
HGB RBC HCT ???
exercise, fear, stress...
9
Red Blood Cells Physiological Alterations
dehydration, shock, high altitude, chronic lung
disease, anabolic steroids...
HGB RBC HCT ???
10
Red Blood Cells Physiological Alterations
anaemia, anaesthesia, sedation, late pregnancy...
HGB RBC HCT ???
11
Red Blood Cells Artefactual Alterations
hemolysis, too little blood, extended storage
in EDTA...
HCT ???
12
Red Blood Cells Regenerative Signs
Reticulocytes
If HCT lt30 (dog) or lt20 (cat) ? count
reticulocytes
13
Red Blood Cells Regenerative Signs
Reticulocytes never in horses!
Not even seen in regenerative anemia in
horses Instead, macrocytes are released RDW
? MCV ?
14
Red Blood Cells Regenerative Signs
Nucleated RBC
Anisocytosis greater variation in cell size, RDW
?
Polychromasia variable coloration
15
Red Blood Cells Regenerative Signs
Howell-Jolly bodies nuclear remnants
Basophilic punctuation
Macrocytosis large cells, MCV ?
16
So What Is This?
17
Red Blood Cells Number and size in mammals
18
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
19
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!
20
Blood Groups in Animals
All animals species have their specific blood
group system.
1. Blood transfusions 2. Incompatibility between
dam and offspring
Cross-matching!
21
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
22
Anemia General Causes
1. Blood loss (regenerative anemia) Coagulopathies
Gastrointestinal hemorrhage Platelet
disorders Splenic rupture Trauma/surgery
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)
25
Platelets The Sealers and Healers
First line of defense in damage to vessels
Important in inflammation and wound healing
26
Platelets Thrombocytopenia PLT ?
Caused by
Production ? Destruction ? Consumption ?
Signs, if PLT lt20-50 x 109/L Hematomas Bleedings
horse
27
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
28
Platelets Thrombocytopenia PLT ?
False Low PLT Caused by
Platelet aggregates
Platelets and fibrin clumps
29
Platelets Thrombocytosis PLT ?
Caused by
Surgery or trauma Chronic bleedings Acute/chronic
infections or inflammatory conditions Cushings
disease Corticosteroid therapy Myeloproliferative
disorders
30
White Blood Cells The defence troops
Defence Cleaning up Inflammatory reactions
Signalling system Cytokines Receptors
31
White Blood Cells The defence troops
First line of defence Phagocytosis
Antibodies Cell destruction
Toxic proteins Parasites Allergic reactions
Interplay Phagocytosis
Allergic reactions Histamin, heparin
32
White Blood Cells Physiological Alterations
breed, sex...
WBC ??/ ??
33
White Blood Cells Physiological Alterations
late pregnancy, feeding...
young animals...
WBC ???
exercise, stress, excitation...
34
White Blood Cells Artefactual Alterations
extended storage...
WBC ???
Cells from very sick animals are the most
sensitive
35
Granulocytes Neutrophils
White, small pink granules
White, no granules
White, small stronger pink granules
White/pink, no granules, knobby nuclei
36
Granulocytes Band Neutrophils
Bands Left Shift
Regenerative left shift Neutrophilia with gt1,0 x
109/L of Bands for dogs and catsgt0,3 x 109/ L of
Bands for horses and cattle
37
Granulocytes Band Neutrophils
Bands Left Shift
Poor Prognosis!
Degenerative left shift Normal or Low WBC count
with significant left shift or Band neutrophils
Segmented neutrophils (with any WBC count)
38
Granulocytes Toxic Neutrophils
Guarded Prognosis!
Basophilic discoloration, foaming, Döhle bodies,
toxic granules
39
Granulocytes Eosinophils
Small rod-shaped orange granules
Very large globular orange granules
Many small round orange granules
40
Granulocytes Basophils
Small oval granules, pale lavender. Rare.
No granules, ribbon-like nucleus, gray-lavender.
Rare.
Small deep purple granules. Low numbers.
Small deep purple granules. Low numbers.
41
Lymphocytes
Small, dense chromatin
Small, dense chromatin
Quite variable
Slightly larger
42
Lymphocytes -Reactive and Granular
Reactive lymphocytes
Granular lymphocytes
Small pink granules
43
Monocytes
Extremely variable in appearance in all animals
44
Avian Hemogram
45
Dogs Hemogram
Excitement (adrenaline epinephrine) Not so much
change All cells (?)
Inflammation WBC ??? Left shift if gt1 x 109/L
bands Neutro ??? (10-30)
Stress (cortico-steroids) WBC ?? Neutro ?? No
left shift Lymph ? Eos ? Mono ?
46
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 gt1 x
109/L bands Neutro ???
47
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 gt0.3 x109/L
bands Neutro ?? (10-20) Severe infectionsWBC
?? Neutro ?? degenerative left shift toxic
changes
48
Cattles Hemogram
Inflammation Acute WBC N/? Marked left shift
(gt0.3 x109/L bands) Chronic WBC ?? (20) Neutro
?? Left shift
Stress (cortico-steroids) WBC N/? No left
shift Lymph ? Eos ?
Excitement (adrenaline epinephrine) WBC ??
(15-27) No left shift Lymph N
49
WBC- General Interpretation
Repeated analyses -gt Best for assessment of
  • pathological conditions
  • duration
  • prognosis

50
WBC- General Interpretation
  • neutrophils ?
  • mild left shift
  • persistent eosinophils

Mild infection that the body can handle well
51
WBC- General Interpretation
  • neutrophils ?
  • mild left shift
  • lymphocytes ?
  • eosinopenia

Moderate or severe infection
52
WBC- General Interpretation
  • immature neutrophils ?
  • segmented neutrophils ?

Grave condition
53
WBC- General Interpretation
  • neutrophils ?
  • no immature neutrophils
  • lymphocytes ?
  • eosinophils ?

Stress (e.g., severe disease, pain) or steroid
influence
54
WBC- General Interpretation
  • monocytes ?

Chronic disease
55
WBC- General Interpretation
  • degenerative left shift
  • falling lymphocyte numbers
  • persistent lymphopenia
  • persistent absence of eosinophils

Each of these signs Unfavourable prognosis
56
WBC- General Interpretation
  • falling WBC count together with increase in
    lymphocyte and eosinophil counts
  • decreasing numbers of immature
    neutrophils

57
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
58
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
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 parameters Platelet count (PLT) Mean
platelet volume (MPV) Plateletcrit (PCT) Platelet
distribution width (PDW)
61
Interpretation Numerical values
Red blood cell parameters Hemoglobin
(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)
62
Interpretation Numerical values
White blood cell parameters White 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 cells
  • Toxic changes
  • Monocytosis
  • Eosinophilia
  • Basophilia
  • Mast cells
  • Leukemia (blast cells)
  • To identify among the red blood cells for
    example.
  • Autoagglutination
  • Eccentrocytes
  • Echinocytes
  • Spherocytes
  • Heinz bodies
  • Nucleated red blood cells
  • Blood parasites in or on erythrocytes
  • Parasites in plasma, e.g. microfilaria

64
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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