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  • Incorporating Differentials Into Every Complete Blood Count

    Paige Flowers, LVT Dogwood Veterinary Internal Medicine

  • Complete Blood Count

    Diagnostic performed to evaluate the quantity and morphology of the cellular components of blood. Automated cell count PCV/TS Manual Differential

  • Sample Collection and Handling

    Fill EDTA tubes until vacuum flow stops Ensures appropriate blood volume to

    anticoagulant ratio Prevents overfilling

    If not analyzed within 2-3 hours, EDTA blood should be refrigerated Minimal changes in refrigerator for up to 24 hours

  • Automated Cell Counters

    Impedance Principle {aka: The Coultier Principle} Quantifies cells Identifies cells by size and density

  • Automated Cell Counters

    Platelet-erythrocyte histograms

    used to evaluate for mechanical errors Overlap in the size of platelets and erythrocytes indicates the

    machine cannot differentiate between the two

  • A clear separation valley must be identified between erythrocyte and platelet peaks

  • Automated Cell Counters

    Laser Light Scatter Laser detection system in a flow cytometer to

    measure size and internal complexity of cells Able to make distinctions that are undetectable

    using impedance

  • Cytogram

  • PCV vs HCT HCT

    (RBCs x MCV) 10 PCV

    Centrifugation of blood to pack erythrocytes and determine a packed cell volume

    The variation between HCT and PCV should not exceed 5%

    Suggests technical error

  • The Differential

    Complements automated cell counters Often provides diagnostic information that an

    automated cell counter cannot Even without an automated cell count

  • The Blood Smear

    Prepare immediately Monolayer

    Provides optimal morphologic detail

    Good distribution Stains well Cells lay flat

  • The Blood Smear

    Only cells with sufficient morphologic detail should be included in the differential cell count A large percentage could be

    cause for concern

  • LEUKOGRAM

    Total and differential leukocyte count

    Assessment of WBC morphologic features.

  • Neutrophils

  • Neutrophils

    Toxic neutrophils Indicates more

    severe disease, a worse prognosis and longer hospital stays

    Moderate to severe toxic changes can cause signs such as fever, vomiting, diarrhea or shock like symptoms

  • Eosinophils

    Orange - pink granules

    Shorter and less segmented than neutrophil nuclei Cytoplasm, if visible, is pale blue.

  • Basophils

    Canine ribbon-like nucleus gray-lavender hue

    Feline

    small, slightly oval granules pale lavender

  • Monocytes

    Variable in size and appearance

    Usually largest leukocyte

    Nucleus can be round to kidney-shaped to pseudo-lobulated

  • Lymphocytes

    small (mature) cells

    round nuclei

    smooth, dense chromatin

    small rim of light blue cytoplasm

  • Lymphocyte sizes

    Lymphocyte size Nucleus size relative to neutrophil Small Nucleus of lymphocyte can fit

    inside a neutrophil Intermediate Nucleus of lymphocyte is the

    same size as a neutrophil Large Neutrophil can fit inside the

    nucleus

  • Reactive Lymphocytes

  • Erythrogram

    Assessment of red blood cell numbers

    Assessment of

    morphologic features

  • Erythropoesis

  • Spherocytes

    More spherical than normal disc shaped erythrocytes

    Do not lay flat - appear smaller

    Darker in color Lack central palor

  • Autoagglutination

    Immune-induced aggregation of erythrocytes into clusters

  • Target Cell

    Resemble a bullseye target

    Regenerative anemia Iron deficiency anemia

  • Acanthocytes

    Club shaped spicules protruding from erythrocyte

  • Howell-Jolly Body

    Blue in color Perfectly round Small fragments of

    nonfunctional nucleus

  • Heinz Body

    Intracellualr inclusions

    Small, round protrusion on the edge of erythrocytes

  • Mycoplasma

    Small, blue cocci or rod-like on the edges or across the faces of erythrocytes

  • Immature neutrophil vs monocyte vs reactive lymphocyte

  • Immature Erythrocyte vs Lymphocyte

  • Thrombogram

    Assessment of platelet numbers

    Assessment of platelet size Assessment of morphologic

    features

  • Macroplatelets

    Large, immature platelet

  • Willard, DVM, MS, DACVIM, Michael, and Harold Tvedten, DVM, PhD, DACVP, DACVCP. "The Complete Blood Count, Bone Marrow Examination and Blood Banking." Small Animal Clinical Diagnosis by Laboratory Methods. Fifth ed. St. Louis: Elsevier, 2012. 12-29. Print. "Hemogram Basics." EClinpath. Cornell University College of Veterinary Medicine, 2013. Web. 16 Oct. 2015.

    Incorporating Differentials Into Every Complete Blood CountComplete Blood CountSample Collection and Handling Slide Number 4Automated Cell Counters Automated Cell CountersSlide Number 7Automated Cell CountersCytogram PCV vs HCT The DifferentialThe Blood SmearThe Blood Smear LEUKOGRAMNeutrophilsNeutrophilsSlide Number 17EosinophilsBasophilsMonocytesLymphocytesLymphocyte sizesSlide Number 23Slide Number 24Slide Number 25Reactive LymphocytesErythrogramErythropoesisSpherocytesAutoagglutination Target CellAcanthocytesHowell-Jolly Body Heinz Body MycoplasmaImmature neutrophil vs monocyte vs reactive lymphocyteSlide Number 37ThrombogramMacroplateletsSlide Number 40Willard, DVM, MS, DACVIM, Michael, and Harold Tvedten, DVM, PhD, DACVP, DACVCP. "The Complete Blood Count, Bone Marrow Examination and Blood Banking." Small Animal Clinical Diagnosis by Laboratory Methods. Fifth ed. St. Louis: Elsevier, 2012. 12-29. Print."Hemogram Basics." EClinpath. Cornell University College of Veterinary Medicine, 2013. Web. 16 Oct. 2015.

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