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Red Cell Cadavers in Anemic Blood (Part 1) Steven Stockham, DVM, MS, DACVP (Clinical Pathology) Kansas State University Manhattan, KS

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Red Cell Cadavers in Anemic Blood (Part 1) Steven Stockham, DVM, MS, DACVP (Clinical Pathology) Kansas State University Manhattan, KS Red Cell Cadavers in Anemic Blood (Part 1) Steven Stockham, DVM, MS, DACVP (Clinical Pathology) Kansas State University Manhattan, KS A thorough examination of erythrocytes (RBCs) in a blood film can provide valuable information about an animal’s anemia. For those who wish to develop their microscopy skills, the following should be considered essential. • Develop techniques to make an excellent blood film that has an even distribution of cells and a good “counting window.” • Have a quality hematologic stain that can provide reproducible results; quick stains can be acceptable • Have a quality microscope that has excellent 40x- or 50x-oil and 100-x oil objectives (these objectives might cost $3000 to $5000 each) • Have excellent textbooks and atlases for the species of interest (see list below) • Have knowledge of the types of anemias that can be found and the many variations of each disorder Erythrocytes in a stained blood film are Red Cell Cadavers – they are cells that died of dehydration (air-dried) and transformed into 2-dimensional shapes that can provide clues to what they were as living cells. Every erythrocyte in a blood film is an artifact – the cell did not have that shape or appearance when it was circulating in blood. A key aspect in blood film evaluations is recognizing artifacts that tell us something about the animal versus artifacts that are distractions. During this session, we will use case information to provide a framework for the evaluation of Red Cell Cadavers. After examining pertinent microscopic fields, an audience response system will be used to assess your knowledge. The reasons for the observed poikilocytosis, anisocytosis, or other erythrocyte abnormalities will be explained. The following tables are located at the end of the document. • Table 3.6. Erythrocyte inclusions other than organisms: identifying features, clinical significance, and associated pathogenic processes • Table 3.7. Poikilocytes: identifying features, clinical significance, and pathogeneses in domestic mammals There are many books that provide images of blood cells and/or explain the significance of abnormal cells. The first listed book (by John Harvey) provides the most comprehensive set of images. The other books can also be valuable. 1. Veterinary Hematology: A Diagnostic Guide and Color Atlas: JW Harvey, 2012 2. Cowell and Tyler’s Diagnostic Cytology and Hematology of the Dog and Cat, 4th ed., A Valenciano, RL Cowell, RD Tyler, 2014 3. Veterinary Hematology Atlas of Common Domestic and Non-Domestic Species, 2nd ed, WJ Reagan, AR Irizarry Rovira, DB DeNicola, 2008 4. Fundamentals of Veterinary Clinical Pathology, 2nd ed, SL Stockham, MA Scott, 2008 5. BSAVA Manual of Canine and Feline Clinical Pathology, 3rd ed., E Villiers, J Ristic, 2016 6. Veterinary Hematology and Clinical Chemistry, MA Thrall, G Weiser, RW Allison, TW Campbell, 2012 7. Duncan & Prasse’s Veterinary Laboratory Medicine; Clinical Pathology; 5th ed., KS Latimer, 2011 8. Atlas of Veterinary Hematology: Blood and Bone Marrow of Domestic Animals, JW Harvey, 2001 1-1 RBC CVC: Blood film from anemic cat • Case: 194644 (98, 435) • Cat, domestic long hair, male(c), 6-yr-old • History: Listless, depressed, weak, and anorectic for 3 days • PE: temp 102.3 °F, heart rate 128/min, resp. rate 80/min, dehydrated (5 %), pale mucous membranes, depressed, weak, and underweight • CBC (plasma mild icterus) pTP 7.4 g/dL 6.0-8.0 WBC (corrected) 7.8 × 103/µL 5.5-19.5 ↓ Hct (s) 22 % 30-45 Seg. neut. 40 % 3.1 × 103/µL 2.5-12.5 ↓ Hct (c) 20 % 30-45 Band neut. 0 % 0.0 × 103/µL 0.0-0.3 ↓ Hgb 6.1 g/dL 9.0-15.0 Lymph. 56 % 4.4 × 103/µL 1.5-7.0 ↓ RBC 3.4 x 106/µL 5.5-10.0 Mono. 4 % 0.3 × 103/µL 0.0-0.8 ↑ MCV 59 fL 39-55 Eos. 0 % 0.0 × 103/µL 0.0-0.8 MCHC 30 g/dL 30-36 Baso. 0 % 0.0 × 103/µL 0.0-0.1 ↑ MCH 18 pg 13-17 ↑ nRBC 41 /100 WBC 0-1 Platelet clumped 247 1-2 RBC CVC: Blood film from anemic cat • Case: 305729 (357, 441) • Cat, domestic long hair, female, 5-mo-old • History: Cat was presented because it was not growing well; it was considerably smaller than its littermate; no other problems were noted by the owner. To increase eating, the owner has been feeding the cat a diet consistent of chicken and vegetables (carrots, celery, & onions). • PE: temp heart rate, and resp. rate OK, not dehydrated, pale mucous membranes, underweight (2.6 lb) • CBC (plasma mild hemolysis) pTP 6.4 g/dL 6.0-8.0 ↑ WBC (corrected) 56.4 × 103/µL 5.5-19.5 ↓ Hct (s) 23 % 30-45 ↑ Seg. neut. 77 % 44.4 × 103/µL 2.5-12.5 ↓ Hct (c) 24 % 30-45 ↑ Band neut. 2 % 1.1 × 103/µL 0.0-0.3 ↓ Hgb 9.5 g/dL 9.0-15.0 Lymph. 10 % 5.6 × 103/µL 1.5-7.0 ↓ RBC 5.4 x 106/µL 5.5-10.0 ↑ Mono. 5 % 2.8 × 103/µL 0.0-0.8 MCV 44 fL 39-55 ↑ Eos. 6 % 3.4 × 103/µL 0.0-0.8 ↑ MCHC 40 g/dL 30-36 ↑ Baso. 1 % 0.6 × 103/µL 0.0-0.1 ↑ MCH 18 pg 13-17 ↑ nRBC 4 /100 WBC 0-1 Platelet clumped 1-3 RBC CVC: Blood film from anemic dog • Case: 074802 (216) • Dog, mixed breed, female (spayed), 9-yr-old • The dog was presented with a complaint of progressive lethargy and inappetence. Physical examination revealed a nonfebrile dog that had icteric mucous membranes and an enlarged spleen. • CBC (plasma icteric) pTP 7.6 g/dL 6.0-8.0 ↑ WBC 39.7 × 103/µL 6.0-17.0 ↓ Hct (s) 30 % 37-55 ↑ Seg. neut. 78 % 31.0 × 103/µL 3.0-11.5 ↓ Hct (c) 31 % 37-55 ↑ Band neut. 11 % 4.4 × 103/µL 0.0-0.3 ↓ Hgb 9.3 g/dL 12.0-18.0 ↓ Lymph. 2 % 0.8 × 103/µL 1.0-4.8 ↓ RBC 3.7 x 106/µL 5.5-8.5 ↑ Mono. 8 % 3.2 × 103/µL 0.2-1.4 ↑ MCV 85 fL 62-76 Eos. 0 % 0.0 × 103/µL 0.0-0.8 ↓ MCHC 30 g/dL 33-37 Baso. 0 % 0.0 × 103/µL 0.0-0.1 MCH 26 pg 21-26 nRBC 0 /100 WBC 0-1 Platelets × 103/µL 200-500 Chemistry profile (serum icteric) + Urea nitrogen 29 mg/dL 9-33 ↓ Na 145 mmol/L 147–154 + Creatinine 0.7 mg/dL 0.5-1.5 K 3.6 mmol/L 3.6-5.3 − ↑ Glucose 150 mg/dL 73-113 ↑ Cl 120 mmol/L 108–118 − Total protein 6.0 g/dL 5.4-7.5 ↓ HCO3 12 mmol/L 18–29 Albumin 3.5 g/dL 3.4-4.2 Anion gap 18 mmol/L 16-26 Globulin 2.5 g/dL 1.3-3.2 ↑ ALT 683 U/L 28-171 Ca2+, total 9.9 mg/dL 9.7-12.1 ↑ ALP 881 U/L 1-142 Phosphorus 2.5 mg/dL 2.4-6.4 ↑ CK 390 U/L 128-328 ↑ Bilirubin, total 3.1 mg/dL 0.1-0.3 Cholesterol 328 mg/dL 133-394 Urinalysis Collection Voided pH 6.5 WBC 0–2 / hpf Color None Protein Neg RBC None / hpf Transp. Clear ↑ Glucose Trace Epithelial cells Occ. Squamous / lpf USGref 1.035 Ketone Neg Casts None / lpf Heme Neg Crystals None / lpf ↑ Bilirubin +3 Bacteria None / hpf Urobilinogen 0.2 1-4 RBC CVC: Blood film from anemic dog • Case: 270417 (1467) • Dog, mixed breed, female, 1-yr-old 248 • The dog was presented with a complaint of progressive weakness of 4 days duration and passing dark tarry stools 3 to 4 times per day the last 2 days. Physical examination revealed a nonfebrile dog that had pale mucous membranes, tachycardia, and mild cardiac murmur. CBC (plasma clear) ↓ pTP 4.2 g/dL 6.0-8.0 ↑ WBC 17.8 × 103/µL 6.0-17.0 ↓ Hct (s) 7 % 37-55 ↑ Seg. neut. 72 % 12.8 × 103/µL 3.0-11.5 ↓ Hct (c) 6 % 37-55 Band neut. 0 % 0.0 × 103/µL 0.0-0.3 ↓ Hgb 1.8 g/dL 12.0-18.0 Lymph. 19 % 3.4 × 103/µL 1.0-4.8 ↓ RBC 1.4 x 106/µL 5.5-8.5 ↑ Mono. 9 % 1.6 × 103/µL 0.2-1.4 ↓ MCV 43 fL 62-76 Eos. 0 % 0.0 × 103/µL 0.0-0.8 ↓ MCHC 30 g/dL 33-37 Baso. 0 % 0.0 × 103/µL 0.0-0.1 ↓ MCH 13 pg 21-26 nRBC 0 /100 WBC 0-1 ↑ Platelets 920 × 103/µL 200-500 1-5 RBC CVC: Blood film from anemic dog • Case: 299404 (518) • Dog, golden retriever, Fe(s), 7-yr-old • Two months prior to this presentation, the dog had a splenectomy for partial management of disseminated mast cell neoplasia involving spleen, lymph nodes, and skin. This presentation was part of a planned appointment to assess progress. The owner reported the dog had been eating and feeling well. Physical examination revealed a swollen left foreleg and edema in the left axillary region. CBC (plasma clear) ↓ pTP 5.2 g/dL 6.0-8.0 WBC 16.9 × 103/µL 6.0-17.0 ↓ Hct (s) 18 % 37-55 ↑ Seg. neut. 87 % 14.7 × 103/µL 3.0-11.5 ↓ Hct (c) 17 % 37-55 Band neut.
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