1.  Erythrocyte Abnormalities Clinical Pathology, Ms. Canga Reading assignment: Lab Pro. Pp 69-76

2. Erythrocyte Morphology  Different species have different _________ RBCs with varying degrees of ___________________________.  Dogs have _____________ RBCs (~________ µm in diameter)  Cats, horses, cows, sheep, goats (3-4 µm)  Llamas and camels have ______________________ (oval) RBCs  Deer have _________________-shaped RBCs  Birds, fish, amphibians, and reptiles have ______________________, elliptical RBCs.  Human RBCs are about the same size as those of ______________.

3. Relative sizes of RBCs

4. Chicken Llama

5. Reptile Deer

6. Feline blood. Normal erythrocyte morphology. Feline RBCs are smaller than dog erythrocytes, exhibit a slight amount of crenation, and have a minimal area of central pallor Normal RBC Morphology

7. Review  There are 5 ways to classify erythrocytes as normal or abnormal:  1) ________________________________________________  2) ________________________________________________  3) ________________________________________________  4) ________________________________________________  5) ________________________________________________

8. Arrangement on a Blood Film  How should cells appear on film?  Abnormal formation  _____________________ formation  _________________________________________

9. Rouleaux Formation  Rouleaux formation  Grouping of RBCs that appear ________________  Normal in _________________  Seen with increased _______________ or ___________________ concentration in blood  May appear as an _________________  Refrigerated blood not allowed to return to room temperature  May be seen if blood has been held too long before preparation of smear

10. Rouleaux as an Artifact  As you learned in Lab Pro, rouleaux formation may be an artifact.  If it IS an artifact and not a true medical condition in the patient, ____________ may be added to the sample.

11. Rouleaux Formation

12. Agglutination/Auto-agglutination  Agglutination is caused by an __________________ that coats the RBC causing bridging or clumping of the cells.  Typically occurs in _________________________ disorders  Agglutination MAY appear as __________________ on occasion  To differentiate between agglutination and rouleaux, saline is added to the sample.  On the next slide, are the EXACT procedures for adding saline to your sample:

13. Adding Saline to Confirm Rouleaux  When rouleaux is suspected, ____________________ all tubes in question.  Carefully remove ___________ with transfer pipette, leaving the cells undisturbed. Discard/use plasma.  Add 2 drops of ________________ to test tube and mix well.  ________________________the tube  Gently re-mix the red cells and perform smear  _________________ will disperse, ______________________________will NOT

14. Comparison in the Monolayer

15. Agglutination can Affect WBCs too!

16. Variation in Color  Called _______________________  ____________________________  Calculated through the ___________ (Remember the formula?)  Classifies cells as ____________________ or _______________________

17. Polychromasia  Variation in color usually associated with __________ and ____________________  ________ production begins right before cell loses nucleus  ____________ intensity decreases as metabolic activity ____________________  ________ increases in intensity as ________ production ______________________.

18. Polychromasia  Recall that the _______________ the cell in the RBC maturation series, the more dark blue the staining due to increased __________________ activity.  Mature RBCs stain _________ because they have their full complement of ________.  ______ production begins right before cell loses ______________; immature RBCs with some Hb present stain ______________________ because there is still some metabolic activity going on within the cell.

19. Hypochromasia  ____________ staining intensity of RBCs  Caused by insufficient ________ concentration due to _________ deficiency (Chronic ____________ loss or ______________________)  Cell will appear normally stained around __________________ with a much paler central region.  Hypochromasia is almost always accompanied by _____________________. (Decreased __________)  Determined by a decreased ______________

20. Hypochromasia

21. Hyperchromasia  Increased staining intensity of RBCs  Immature RBCs = larger and darker  Hyperchromasia based on _______ concentration (_______) cannot exist…  Presence of _______________, ___________________, and _____________can interfere with tests and _______________________ increase MCHC  _____________________ often seen  are __________________and __________________but can have normal cell volume. (Cell may be ________________)  May be seen in mismatched _________________________

22. Hyperchromasia/Spherocytes

23. Canine blood. Regenerative anemia with spherocytes. Anisocytosis is due to macrocytic cells and spherocytes, which are smaller than normal and lack central pallor. Spherocytes are associated with hemolytic anemias due to immune disease or fragmentation. The polychromatophilic RBC with a rod- shaped area of central pallor (arrow) is a stomatocyte

24.  Variations in the __________________ of RBCs (poikil ~ irregular)  Not a __________________________  A general term to encompass nondescript variations in ______________ of erythrocytes that are scattered throughout the blood film. Poikilocytosis

25. Note: Poikilocytosis, anisocytosis, and polychromasia are present on this slide.

26.  RBC fragments resulting from shearing of red blood cell by _________________________________.  May be seen with _______________________________________ (DIC) or with ________________________  Expect to also see ________________________________ on blood film of animals with DIC  Can be caused by excess _______________deposition, malformation of _______________________, or excessive _________________________in the blood  Common name is “__________________________” Schistocytes “Fragmented Cell”

27. Schistocytes

28.  Have irregular membrane projections of _______________________ length and diameter with __________________________tips  _______________________sized and spaced  May be seen in blood smear of:  Cats with _____________________________________,  Dogs with ___________________disease or  ____________________________of the liver  Represent __________________ alteration rather than ________________________  Commonly called “________________” Acanthocytes “Spur Cells”

29. Acanthocytes

30.  __________________ change  Resulting from _____________ change in blood, altering cell _____________________  May appear __________________ or ruffled, with relatively _____________ sized and spaced, short, _________ projections  Associated with ____________ disease, ____________________ or rattlesnake _________________________in dogs  Can be _____________________ if excess of _______ is present Echinocytes “Burr Cells ”

31. Echinocyte formation

32. Echinocytes

33.  __________________ Change  ______________________  Slow ________________ of blood film  _____________________EDTA tube  Affects the ________________ of the cells on a blood film Echinocytes as“Crenation”

34. Crenation

35.  ________________________ with pointed ends  Result of alteration in __________ due to low ___________ tension  Normal finding in ___________, Angora _________, and some ___________ Drepanocytes “Sickle Cells”

36. Drepanocytes

37. Drepanocyte

38.  Also called “________________”  Keratocytes are believed to result from ____________________________________  Can also result from _________________ injury found with ___________ deficiency  Presence of keratocytes has also been associated with ____________________, _________________, ________________________, and various _________________ diseases. Keratocytes “Helmet cell”

39. Keratocytes and Pre-keratocytes

40.  ____________ shaped RBCs that form as a result of a loss of the membrane ____________________.  Cell cannot return to normal shape after passing through a narrow _____________________.  May be seen in any _______________ disease.  Can also occur due to low _______ concentration or as an ____________________. Anulocytes “Punched-out cells”

41. Anulocytes (Punched-out cells)

42.  _________________ shaped RBCs with a single ____________________ or _______________end  May be seen in _________________________ diseases or ____________ and ________________ disorders of dogs.  Can be an ______________. Check to see if the _______________ are all pointing in the __________ direction. Dacryocyte “Teardrop cells”

43. Dacryocytes “Tear-drop Cells”

44. Eccentrocyte  Characterized by a shifting of the _______________ to one side of the RBC  ____________ portion of membrane is ragged and poorly _______________________________.  Form under conditions of ___________________ stress  May be seen with ____________________________Anemia

45. Eccentrocyte

46. Leptocytes  Characterized by an increase in membrane _________________ _________  Include all of the following cells:  __________________________

47.  Resembles a ____________ with a bulls-eye  Have central area of _____________ surrounded by area of pallor  _________________ of cell contains band of _______  A few may be seen in _____________ smears  May be associated with __________ deficiency, _________, ___________ diseases, and some _______________ disorders. Codocytes (Target Cells)

48. Codocytes/Target Cells

49.  Folded cells have a ______________ _____appearing central pallor  _____________________ have a transverse, raised fold extending across the center of the cell and a clear, _________- like pale region in the center.  Both may be caused by a change in membrane _____________ associate with ______________ disease  Both are considered an ___________________ if the areas of pallor are ________________________ to the feathered edge. Folded cells and Stomatocytes

50. Stomatocyte

51. Stomatocytes

52. Folded Cells

53. Knizocytes (Barr Cells)  Appear to have a bar of _________ through the central pallor.  Commonly observed in chronic ______________ disease  May be observed in any acute ______________ dysfunction  Caused by an alteration in the ______________ content of cell membrane

54. Knizocytes or “Barr Cells”

55. Some Poikilocytes at a glance

56. Test yourself!

57. Presence of Structures on/in Erythrocyte  Many different abnormalities caused by variety of different conditions.  __________________________

58. Howell-Jolly bodies  __________________________ nuclear remnants observed in young RBCs during their response to __________________________ anemia  Normally, as cells containing nuclear remnants pass through the _______________, _________________ cells remove the remnants.  Therefore, HJBs may be seen with ________________ disease or in an animal with the _____________removed.

59. Howell-Jolly bodies

60.  Observed in RBCs that contain abnormal, residual ___________.  Small, dark blue “__________________” within the RBC.  Occasionally seen in __________________ RBCs in _____________ cats.  Characteristic finding with __________________________ in dogs. Basophilic Stippling

62.  Particles of __________________________, resulting from oxidative injury, attach to RBC _______________________.  They stain blue with _________________________________ and appear as a _________________ area with Diff-quick stain.  Seen in _________________________ and ______________ ingestion in cats and dogs  HBs are often increased in concentration with diseases such as _____________________, ______________________, and ______________________________ in cats  Normal cat blood may have up to _____% Heinz Bodies

63. Heinz bodies

64. Reticulocytes  Immature RBC; contains _________________ (ribosomes) and residual RNA that are lost as the cell matures.  A.k.a. ‘____________________________ RBC’ (when stained with _______________________ and not NMB)  NMB causes visualization of clumping of residual organelles, referred to as ‘______________________’.  Cats have two forms: ___________________ and _____________________.

65. Reticulocytes

66. Canine Distemper Viral Inclusions  Seen in RBCs of dogs with _________________.  __________________________  Variable in _________, __________, ________ and _________(faint blue to magenta).  More frequently seen in ________________________ RBCs than _______________RBCs.  Can also be seen in ___________________ and _____________________.

67. Viral Distemper inclusions

68.  From a student Disemper Viral Inclusion

69. Blood Parasites that Affect RBCs  Parasites may be present ____________ or _____ the surface of RBCs  Stain ___________________ and drying ________________ are sometimes confused with RBC parasites.

70. Babesia spp.  _____________________ or __________shaped, ______________________, paired inclusions  Transmitted via ______________  Causes ___________________ anemia  Commonly identified at __________________ edge of blood smears  Seen in __________, __________, __________, __________, and ______________

71. Babesia spp.

72.  Formerly known as: ____________________________  Disease = Feline Infectious __________________ Anemia  May be, coccoid, rod-shaped, or ringlike structures, but usually appear as short, dark purple ________on the __________________ of RBCs  Organisms usually detach from the RBC when placed in _________________________.  Cyclic ____________________, organisms may be numerous, scarce or not found in a given blood sample – examine blood at different _____________of the day  May be transmitted by ______________ Mycoplasma haemofelis

74. Mycoplasma haemocanis  Formerly known as ___________________________  Rare; Usually only occurs in ________________________ or immunosuppressed dogs.  Organism appears as a chain or small cocci or rods that stretch across _____________ of RBC.  Chains may appear “_____________________.”

75. Mycoplasma haemocanis

76. Cytauxzoon felis  S mall, ring or _______________-shaped bodies in red cells  Causes a ______________ disease in cats  Transmission is by ____________  Rare cause of _________________ anemia  No known _________________

77. Cytauxzoon felis

78. Cytauxzoon felis seen extracellularly 