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LIC - Veterinary Hematology

LIC - Veterinary Hematology

John W. Harvey

(2011)

Abstract

Combining essential hematology content with the diagnostic features of an atlas, Veterinary Hematology: A Diagnostic Guide and Color Atlas delivers all the information you need to accurately assess and diagnose the blood diseases of common domestic animals — including dogs, cats, horses, cattle, sheep, goats, pigs, and llamas. This all-in-one resource utilizes a clinically-oriented and user-friendly approach to guide you through the processes of selecting relevant diagnostic tests, collecting and preparing samples, interpreting sample results, and determining their clinical significance. High-resolution photomicrographs, full-color illustrations, and excellent schematic drawings, tables, and quick-reference algorithms help you clearly visualize these concepts and procedures.

  • Two books in one gives you the information of a user-friendly, clinical textbook and the diagnostic features of a color atlas in a single reference.
  • Practical, clinically-relevant text is comprehensive and yet concise in its delivery of vital information such as:
    • Principles and procedures that are employed in recognizing normal, abnormal, and artifactual features of blood and bone marrow samples and developing accurate diagnoses
    • Common cytochemical stains and summary charts for interpretation
    • Sample collection, staining procedures, and diagnostic techniques
    • Differentiating features of malignant and benign hematologic disorders
    • Miscellaneous cells and blood parasites and their significance in the evaluation of blood smears
    • Hematopoietic and non-hematopoietic neoplasms

  • High- resolution photomicrographs and excellent schematic drawings, tables, boxes and quick-reference algorithms aid your understanding of basic clinical concepts and differential diagnostic considerations.
  • Over 800 full-color illustrations help you clearly visualize the concepts and clinical features of the blood and bone marrow — from normal cell maturation to the development of various pathologies.

Table of Contents

Section Title Page Action Price
Front Cover cover
Inside Front Cover ifc1
Veterinary Hematology i
Copyright Page ii
Dedication iii
Foreword Benefits for the Veterinarian and the Veterinary Clinical Pathologist iv
Foreword Benefits for the Veterinary Technician v
Preface vi
Acknowledgments vii
Table Of Contents viii
1 Introduction to Veterinary Hematology 1
Internal Versus External Laboratories 1
Reference Intervals 2
Selection of Reference Animals 2
Determination of Reference Intervals 2
Interpretation of Test Results Relative to Reference Intervals 3
Use of Published Reference Intervals 3
Sensitivity and Specificity of Tests 3
Predictive Values and Disease Prevalence 4
Cutoff Values 6
Accuracy Versus Precision 6
Automated versus Manual Methods 8
Critical Difference 9
References 10
2 Hematology Procedures 11
Composition of Blood 11
Calculation of Blood Volume 11
Sample Collection and Handling 11
Gross Examination of Blood Samples 12
Methemoglobinemia 12
Erythrocyte Agglutination 13
Microhematocrit Tube Evaluation 14
Packed Cells 15
The Appearance of Plasma 15
Plasma Protein Determination 15
Fibrinogen Determination 16
Blood Cell Counting and Sizing 16
Manual Cell Counting 16
Automated Cell Counting 17
Errors in Blood Cell Counting and Sizing 17
Quality Control 18
Blood-Film Preparation 18
Glass-Slide Blood-Film Method 18
Coverslip Blood-Film Method 19
Blood-Film Staining Procedures 19
Romanowsky-Type Stains 19
Reticulocyte Stains 21
New Methylene Blue “Wet Mounts” 22
Iron Stains 22
Cytochemical Stains 23
Examination of Stained Blood Films 23
Leukocyte Evaluation 24
Erythrocyte Morphology 26
Platelets 26
Degenerative Changes in Blood Samples 27
Infectious Agents or Inclusions of Blood Cells 27
Miscellaneous Cells and Parasites in Blood 28
Mitotic Cells 28
Free Nuclei 28
Endothelial Cells 28
Megakaryocytes 28
Microfilaria 29
Trypanosoma Species 29
Bacteria 30
References 30
3 Hematopoiesis 33
Overview 33
Sites of Blood Cell Production 33
Organization of Bone Marrow 33
Hematopoietic Stem Cells and Progenitor Cells 34
Mesenchymal Stem Cells 35
Homing of Hematopoietic Stem Cells and Progenitor Cells to the Marrow 37
Hematopoietic Microenvironment 37
Hematopoietic Growth Factors 38
Erythropoiesis 38
Primitive Erythropoiesis 38
Hematopoietic Progenitor Cells and the Bone Marrow Microenvironment 38
Nutrients Needed for Erythropoiesis 39
Maturation of Erythroid Cells 39
Control of Erythropoiesis 41
Leukopoiesis 42
Neutrophil Production 42
Eosinophil, Basophil, and Mast Cell Production 43
Production of Monocytes, Macrophages, Dendritic Cells, and Osteoclasts 43
Lymphocyte and NK Cell Production 44
Thrombopoiesis 45
References 45
4 Evaluation of Erythrocytes 49
Normal Erythrocytes 49
Erythrocyte Morphology 49
Erythrocyte Functions 49
Erythrocyte Biochemistry 50
Membrane Structure and Function 50
ATP Generation 51
2,3DPG Pathway 52
Oxidant Injury 52
Protection against Oxidant Injury. 52
Methemoglobin Formation and Reduction 54
Iron Metabolism 54
Iron Absorption. 54
Systemic Control of Iron Metabolism. 56
Plasma Iron. 56
Iron Uptake by Erythroid Cells. 56
Macrophage Iron Metabolism. 56
Erythrocyte Destruction 57
Normal Removal of Aged Erythrocytes 57
Pathologic Destruction of Erythrocytes 58
Abnormal Erythrocyte Morphology 59
Rouleaux 59
Agglutination 59
Polychromasia 59
Anisocytosis 61
Hypochromasia 62
Poikilocytosis 63
Echinocytes (Crenated Erythrocytes) 65
Acanthocytes 66
Keratocytes 67
Stomatocytes 67
Spherocytes 68
Schistocytes 69
Leptocytes 70
Eccentrocytes 70
Pyknocytes 71
Elliptocytes (Ovalocytes) 71
Dacryocytes 73
Drepanocytes (Sickle Cells) 73
Crystallized Hemoglobin 75
Lysed Erythrocytes 76
Erythroid Loops 76
Erythrocyte Vesicles 76
Nucleated Erythrocytes 78
Inclusions of Erythrocytes 79
Howell-Jolly Bodies (Micronuclei) 79
Heinz Bodies 79
Basophilic Stippling 80
Siderotic Inclusions 80
Cabot Rings 82
Infectious Agents of Erythrocytes 82
Babesia Species 82
Theileria Species 86
Cytauxzoon felis 86
Anaplasma Species 86
Distemper Inclusions 86
Hemotropic Mycoplasmas (Hemoplasmas) 87
Bartonella Species 90
Artifacts Resembling Infectious Agents 90
Erythrocyte Assays 90
Erythrocyte Counts, Hematocrit, and Hemoglobin Content 90
Reticulocyte Counts 91
Erythrocyte Indices 93
Mean Cell Volume 93
Mean Cell Hemoglobin Concentration 94
Mean Cell Hemoglobin 95
Red Cell Distribution Width 95
Erythrocyte Volume Histograms and Erythrocyte Cytograms 96
Direct Antiglobulin Test 96
Methemoglobin Determination 96
Toxic Methemoglobinemia 97
Cytochrome-b5 Reductase Deficiency 97
Serum Iron Assays 97
Serum Iron 97
Total Iron-Binding Capacity 98
Serum Ferritin 98
Erythropoietin Assay 98
Differential Diagnosis of Anemia 98
Regenerative Versus Nonregenerative Anemia 99
Classification of Anemia Using Erythrocyte Indices 99
Hemolytic Anemias 99
Immune-Mediated Hemolytic Anemia 101
Primary IMHA 101
Neonatal Isoerythrolysis 101
Transfusion Reactions 101
Erythrocyte Parasites 102
Babesia Species 102
Theileria Species 102
Cytauxzoon felis 102
Anaplasma Species 103
Hemotropic Mycoplasmas (Hemoplasmas) 103
Other Infectious Agents 103
Chemicals and Plants 104
Oxidants 104
Venoms 104
Drugs Causing Immune-Mediated Anemia 104
Fragmentation 104
Hypo-osmolality 104
Hypophosphatemia 104
Hereditary Erythrocyte Defects 105
Pyruvate Kinase Deficiency in Dogs and Cats 105
Phosphofructokinase Deficiency in Dogs 105
Increased Erythrocyte Osmotic Fragility in Cats 105
Hereditary Spherocytosis in Cattle 105
Glucose-6-Phosphate Dehydrogenase Deficiency in a Horse 105
Erythrocyte Flavin Adenine Dinucleotide Deficiency in Horses 106
Hereditary Stomatocytosis in Dogs 106
Additional Hereditary Defects 106
Miscellaneous Causes of Hemolytic Anemia 106
Splenic Disorders 106
Liver Failure in Horses 106
Postparturient Hemoglobinuria in Dairy Cattle 106
Blood-Loss Anemias 106
Anemias Resulting from Decreased Erythrocyte Production 107
Nonregenerative Anemias without Leukopenia or Thrombocytopenia 108
Hormone Deficiencies 108
Anemia of Inflammatory Disease (Anemia of Chronic Disease) 108
Disorders of Nucleic Acid Synthesis 108
Abnormalities in Heme Synthesis 108
Nonregenerative Immune-Mediated Anemia 109
Selective Erythroid Aplasia 109
Dyserythropoiesis 109
Nonregenerative Anemias with Leukopenia and/or Thrombocytopenia 109
Hypocellular/Aplastic Bone Marrow 109
Myelophthisic Disorders 110
Physiologic Anemia of Neonatal Animals 110
Erythrocytosis (Polycythemia) 111
Relative Erythrocytosis 111
Absolute Erythrocytosis 112
Differential Diagnosis of Erythrocytosis 112
References 112
5 Evaluation of Leukocytic Disorders 122
Leukocyte Types and Numbers in Blood 122
Leukocyte Kinetics 122
Neutrophils 122
Eosinophils and Basophils 124
Monocytes 124
Lymphocytes 124
Leukocyte Functions 125
Neutrophil Functions 125
Eosinophil Functions 127
Basophil Functions 128
Monocyte/Macrophage/Dendritic-Cell Functions 129
Monocyte Functions 129
Macrophage Functions 129
Dendritic-Cell Functions 129
Lymphocyte and NK Cell Functions 130
CD4+ T Lymphocyte Functions 130
CD8+ T Lymphocyte Functions 130
B Lymphocyte Functions 131
NK Cell Functions 132
Neutrophils 132
Normal Neutrophil Morphology 132
Morphology of Left Shifts 133
Myeloblasts 133
Promyelocytes 133
Myelocytes 133
Metamyelocytes 133
Band Neutrophils 133
Disorders with Left Shifts 134
Inflammation 134
Chronic Myeloid Leukemia 134
Pelger-Huët Anomaly (Hyposegmentation) 134
Hypersegmentation 135
Toxic Cytoplasm 136
Foamy Basophilia 137
Döhle Bodies 137
Toxic Granulation 137
Granules and Inclusions 137
Normal Foals 137
Lipemia in a Horse 137
Lysosomal Storage Diseases 137
Birman Cats 137
Reddish Granulation in Cats 137
Chédiak-Higashi Syndrome 137
May-Hegglin Anomaly 140
Siderotic Inclusions 140
Infectious Agents 140
Distemper Inclusions 140
Rickettsial Species 140
Hepatozoon Species 142
Miscellaneous Bacteria, Fungi, and Protozoa 143
Miscellaneous Neutrophil Morphologic Abnormalities 143
Giant Neutrophils 143
Karyolysis 144
Pyknosis and Karyorrhexis 144
Cytoplasmic Vacuoles 144
Phagocytized Eosinophil Granules 144
Stain Precipitation 144
Neutrophilia 144
Neutropenia 146
Inherited Neutrophil Defects 147
Chédiak-Higashi Syndrome 147
β2 Integrin Adhesion Molecule Deficiencies 148
Kindlin-3 Deficiency 148
Unknown Neutrophil Function Defects 148
Cyclic Hematopoiesis 148
Eosinophils 148
Eosinophil Morphology 148
Eosinophilia 150
Eosinopenia 150
Basophils 151
Basophil Morphology 151
Basophilia 151
Mast Cells 151
Mast Cell Morphology 151
Mastocytemia 152
Monocytes 153
Monocyte Morphology 153
Monocytosis 155
Lymphocytes 156
Lymphocyte Morphology 156
Normal Lymphocyte Morphology 156
Reactive Lymphocytes 157
Cytoplasmic Granules, Vacuoles, and Inclusions 158
Neoplastic Large Granular Lymphocytes, Plasma Cells, and Mott Cells 158
Lymphocytosis 160
Lymphopenia 162
Blast Cells or Poorly Differentiated Cells 163
Lymphoblasts 163
Myeloblasts 165
Monoblasts 165
Rubriblasts 166
Megakaryoblasts 166
Neoplastic Dendritic Cells 167
Unclassified Blast Cells 167
Metastatic Blast Cells 167
References 168
6 Immunohematology 177
Immune System 177
Innate Immunity 177
Acquired Immunity 177
Tests for Immune-Mediated Disorders 177
Tests for Antierythrocyte Antibodies 177
Direct Antiglobulin Test or Coombs’ Test 177
Direct Immunofluorescence Flow Cytometry Assay 178
Direct Enzyme-Linked Antiglobulin Test 178
Blood Typing 178
Blood Cross-Match Tests 179
Tests for Antinuclear Antibodies 179
ANA Test 179
Lupus Erythematosus Cell Test 180
Tests for Antiplatelet Antibodies 180
Primary Immune-Mediated Disorders 180
Transfusion Reactions 181
Neonatal Isoerythrolysis 181
Primary Immune-Mediated Hemolytic Anemia 181
Primary Immune-Mediated Thrombocytopenia 182
Primary Immune-Mediated Neutropenia 183
Systemic Lupus Erythematosus 183
Tests for Immune Deficiency Disorders 184
Neutrophil Function Tests 184
Lymphocyte Assays 184
Serum Immunoglobulin Assays 184
Immunodeficiency Disorders 185
Clinical Signs 185
Inherited Neutrophil Defects 185
Severe Combined Immunodeficiency 185
Severe Combined Immunodeficiency Syndrome in Arabian Foals 185
Severe Combined Immunodeficiency Syndrome in Jack Russell Terriers 185
X-linked Severe Combined Immunodeficiency Syndrome in Dogs 185
Serum Immunoglobulin Deficiencies 186
Common Variable Immunodeficiency 186
Fell Pony Syndrome 186
Selective Immunoglobulin Deficiencies 186
Immunodeficiency in Cavalier King Charles Spaniels 186
X-linked Agammaglobulinemia in Foals 186
Immunodeficiency in Weimaraner Dogs 186
Transient Hypogammaglobulinemia in Neonates 186
T Lymphocyte Immunodeficiency 186
T Lymphocyte Immunodeficiency in Growth Hormone-Deficient Dogs 186
Hypotrichosis with Thymic Aplasia in Cats 186
Lethal Acrodermatitis in English Bull Terriers 187
Complement Deficiency in Brittany Spaniel Dogs 187
Viral Immune Deficiency Disorders 187
Failure of Passive Transfer of Immunoglobulins 187
References 187
7 Evaluation of Hemostasis: 191
Blood Platelets (Thrombocytes) 191
Normal Morphology 191
Platelet Life Span and Counts in Blood 191
Platelet Metabolism 192
Primary Hemostasis 194
Vascular Phase 194
Platelet Phase 194
Platelet Adhesion 194
Platelet Activation 195
Change in Platelet Shape 196
Platelet Secretion 196
Platelet Aggregation 196
Platelet Procoagulant Activity 197
Secondary Hemostasis 198
Overview 198
Initiation of Coagulation (Activation of the Extrinsic Pathway or Tissue Factor Pathway) 198
Amplification of Coagulation 199
Propagation of Coagulation (Activity of the Intrinsic Pathway) 199
Factor XII Activation of Factor XI 199
Thrombin Activation of FXI 200
Stabilization of the Thrombus 200
Inhibitors of Thrombus Formation 201
Inhibition of Platelet Aggregation 201
Antithrombin 201
Protein C Anticoagulant Pathway 201
Tissue Factor Pathway Inhibitor 201
Platelet-Secreted Inhibitors 201
Additional Coagulation Inhibitors 201
Fibrinolysis 202
Anticoagulants 202
Screening Tests For Hemostatic Disorders 203
Platelet Count 203
Mean Platelet Volume 203
Bleeding Time 204
Activated Clotting Time 204
Activated Partial Thromboplastin Time 204
Prothrombin Time 205
Thrombin Clotting Time 205
Fibrinogen 205
Fibrin(ogen) Degradation Products and D-Dimer Assays 205
FDP Assays 205
D-Dimer Assays 206
Thromboelastography 206
Specialized Tests for Hemostatic Disorders 207
von Willebrand Factor 207
Antithrombin 207
PIVKA (Proteins Induced by Vitamin K Absence or Antagonism) 207
Reticulated Platelet Count 207
Platelet Function 208
Flow Cytometry 208
Platelet Function Analyzer 208
Platelet Aggregation 208
Platelet Secretion 208
Antiplatelet Antibody 208
Specific Coagulation Factors 209
Clinical Signs Of Hemostatic Disorders 209
Platelet Disorders 209
Abnormal Platelet Morphology 209
Macrothrombocytes 209
Activated Platelets 209
Hypogranular Platelets 210
Anaplasma platys Infection 210
Thrombocytopenia 211
Decreased Platelet Production 213
Increased Platelet Utilization 213
Increased Platelet Destruction 214
Sequestration of Platelets 214
Massive External Hemorrhage 214
Infections and Thrombocytopenia 215
Drug- and Chemical-Induced Thrombocytopenia 215
Neoplasia and Thrombocytopenia 216
Inherited Thrombocytopenia 216
Pseudothrombocytopenia 216
Abnormalities in Platelet Function Acquired Defects in Platelet Function 216
Inherited Platelet Function Defects 217
von Willebrand Disease 217
Thrombocytosis 218
Coagulation Disorders 219
Acquired Coagulation Disorders 219
Hypercoagulable State 219
Thromboembolism (Localized Thrombosis) 219
Disseminated Intravascular Coagulation 220
Hemolytic-Uremic Syndrome 221
Antiphospholipid Antibody 221
Liver Disease 222
Vitamin K Deficiency 222
Snake Venoms 222
Hereditary Coagulation Disorders 223
Factor XII and Prekallikrein Deficiencies 223
Factor XI Deficiency 223
Factor IX and Factor VIII Deficiencies 223
Factor VII Deficiency 223
Defects in the Common Coagulation Pathway 223
Vitamin K-Dependent Coagulopathies 223
Interpretation Of Hemostatic Test Profiles 224
References 224
8 Bone Marrow Examination 234
Reasons to Examine Bone Marrow 234
Sites for Bone Marrow Biopsy 234
Ilium 234
Proximal Femur 234
Proximal Humerus 235
Sternum 235
Proximal Ribs 235
Other Sites 235
Technique of Bone Marrow Aspiration 235
Technique of Bone Marrow Core Biopsy 238
Morphologic Identification of Cells 240
Megakaryocytic Series 240
Erythrocytic Series 240
Rubriblasts 240
Prorubricytes 242
Basophilic Rubricytes 242
Polychromatophilic Rubricytes 242
Metarubricytes 242
Polychromatophilic Erythrocytes (Reticulocytes) 242
Granulocytic Series 242
Myeloblasts 242
Promyelocytes (Progranulocytes) 242
Myelocytes 242
Metamyelocytes 243
Band Cells 243
Segmented Granulocytes 243
Monocytic Series 243
Macrophages 244
Lymphocytes 245
Plasma Cells 245
Osteoclasts 247
Osteoblasts 247
Mitotic Figures 247
Miscellaneous Cells and Free Nuclei 248
Organized Approach to Bone Marrow Evaluation 250
Cellularity 251
Megakaryocytes 251
Erythroid Cells 254
Granulocytic Cells 254
Myeloid-to-Erythroid Ratio 254
Lymphocytes 254
Plasma Cells 255
Mononuclear Phagocytes 255
Other Cell Types 255
Stainable Iron 256
Interpretation 258
References 258
9 Disorders of Bone Marrow 260
Generalized Increases in Hematopoietic Cells 260
Generalized Decreases In Hematopoietic Cells 260
Hypocellular/Aplastic Bone Marrow 260
Acute Bone Marrow Injury and Necrosis 263
Gelatinous Transformation of Bone Marrow 264
Myelofibrosis 265
Generalized Osteosclerosis/Hyperostosis 268
Abnormalities of The Erythroid Series 268
Erythroid Hyperplasia 268
Selective Erythroid Hypoplasia or Aplasia 270
Dyserythropoiesis 273
Abnormalities of The Granulocytic Series 275
Granulocytic Hyperplasia 275
Neutrophilic Hyperplasia 275
Eosinophilic Hyperplasia 277
Basophilic Hyperplasia 278
Granulocytic Hypoplasia 278
Selective Neutrophilic Hypoplasia or Aplasia 279
Dysgranulopoiesis 280
Abnormalities of Megakaryocytes 283
Megakaryocytic Hyperplasia 283
Selective Megakaryocytic Hypoplasia or Aplasia 284
Dysmegakaryocytopoiesis 284
Emperipolesis 285
Abnormalities of Mononuclear Phagocytes 286
Monocytic Hyperplasia 286
Reactive Macrophage Hyperplasia 286
Phagocytosis of Blood Cells and Their Precursors 286
Histiocytic Sarcoma 293
Inflammatory Disorders of Bone Marrow 293
Acute Inflammation 293
Fibrinous Inflammation 293
Chronic Inflammation/Hyperplasia 294
Chronic Granulomatous Inflammation 294
Hematopoietic Neoplasms 296
Lymphoid Neoplasms 298
Acute Lymphoblastic Leukemia 298
Chronic Lymphocytic Leukemia 300
Lymphomas 301
Multiple Myeloma and Other Immunoproliferative Neoplasms 302
Multiple Myeloma 302
Extramedullary Plasmacytoma 305
Other B Lymphocyte Neoplasms 305
Myeloid Neoplasms 306
Myelodysplastic Syndromes 307
Acute Myeloid Leukemias 309
AML-M1 309
AML-M2 309
AML-M3 311
AML-M4 311
AML-M5 311
AML-M6 312
AML-M7 312
Acute Undifferentiated Leukemia 313
Peripheral Blood Findings 313
Frequency in Animal Species 313
Myeloproliferative Neoplasms 314
Chronic Myeloid Leukemia 314
Eosinophilic Leukemia 315
Basophilic Leukemia 315
Primary Erythrocytosis 315
Essential Thrombocythemia 315
Nonhematopoietic Neoplasms 315
Mast Cell Tumors 316
Metastatic Neoplasms 316
Sarcomas of Bone 317
References 318
Appendix I Tables 328
Example of Bone Marrow Evaluation and Interpretation 328
Appendix II Algorithms 336
Appendix III Case Studies 343
Case 1: Estrogen-Induced Aplastic Anemia 343
Notable Laboratory Findings 343
Assessment 343
Comment 343
References 343
Case 2: Acute Lymphoblastic Leukemia 344
Notable Laboratory Findings 344
Assessment 344
Comment 344
Reference 344
Case 3: Iron-Deficiency Anemia 345
Notable Laboratory Findings 345
Assessment 345
Comment 345
Reference 345
Case 4: Mycoplasma Haemofelis Infection 346
Notable Laboratory Findings 346
Assessment 346
Comment 346
Reference 346
Case 5: Vaginal Tear 347
Notable Laboratory Findings (Day 1) 347
Index 351
A 351
B 352
C 352
D 353
E 353
F 354
G 354
H 355
I 355
J 356
K 356
L 356
M 356
N 357
O 358
P 358
Q 359
R 359
S 359
T 359
U 360
V 360
W 360
X 360