犬貓貧血的實(shí)驗(yàn)室診斷

1、講座二 貧血的實(shí)驗(yàn)室診斷原著 Professor Michael J. Day翻譯：劉睿 獸醫(yī)師（廣州），校對(duì)：戴庶 獸醫(yī)師（廣州） 前言如果要對(duì)貧血?jiǎng)游镒龀龀晒Φ脑\斷和管理，不可或缺一定水準(zhǔn)的實(shí)驗(yàn)室檢查。血液學(xué)檢查可在院內(nèi)做；或保存為EDTA抗凝血后，送檢至商業(yè)診斷實(shí)驗(yàn)室。要進(jìn)行基本的血液分析，最低限度的實(shí)驗(yàn)室設(shè)備應(yīng)包括：微量血細(xì)胞比容法離心機(jī)和毛細(xì)管判讀器、制備染色血涂片的材料、用于評(píng)估血涂片所用的顯微鏡。準(zhǔn)備一臺(tái)折射儀來(lái)測(cè)定血漿蛋白含量也是有價(jià)值的。如今，臨床實(shí)驗(yàn)室已經(jīng)有條件使用日趨精密的檢測(cè)設(shè)備來(lái)進(jìn)行血液分析。雖然大部分的檢測(cè)設(shè)備能夠獲得可信的紅細(xì)胞和白細(xì)胞數(shù)據(jù)，但血小板的檢測(cè)值可能被

2、低估。在使用儀器檢測(cè)血樣的同時(shí)，應(yīng)配合血涂片鏡檢。本講座回顧了紅細(xì)胞參數(shù)的相關(guān)知識(shí)，也包括血涂片檢查中可能遇見的各種紅細(xì)胞形態(tài)學(xué)改變情況。 紅細(xì)胞參數(shù)紅細(xì)胞計(jì)數(shù)，PCV和Hb紅細(xì)胞壓積（PCV）是指紅細(xì)胞總數(shù)(RBCs)所占全血中的體積比。PCV測(cè)量：通過(guò)離心微量紅細(xì)胞壓積管后，人工判讀數(shù)據(jù)，并記錄為占血液總量百分比。血細(xì)胞壓積（HcT）通過(guò)自動(dòng)血液分析儀在細(xì)胞大小和數(shù)量的基礎(chǔ)上判定。紅細(xì)胞總數(shù)可使用自動(dòng)化儀器，或血細(xì)胞計(jì)數(shù)器在鏡下計(jì)數(shù)來(lái)獲得，用RBC ×1012/l 表示。血液中的血紅蛋白（Hb）含量同樣也可以使用自動(dòng)化儀器判定，記錄為g/dl。Hb（血紅蛋白）的含量測(cè)定受血液樣本

3、中存在脂血癥、紅細(xì)胞溶解癥或膽紅素血的影響。一個(gè)檢驗(yàn)結(jié)果精確性的簡(jiǎn)單方法：3 ×Hb= Ht（血細(xì)胞壓積）。檢測(cè)到的數(shù)值要參照“正常范圍值”來(lái)比較，但要明確“正常范圍值”并不適用于所有情況。舉例來(lái)說(shuō)，初生或者懷孕動(dòng)物可能會(huì)呈現(xiàn)數(shù)值偏差，并且某些動(dòng)物也存在品種效應(yīng)（例如，視覺獵犬 (sight hounds)就呈現(xiàn)高PCV值和低嗜中性粒細(xì)胞計(jì)數(shù)）。PCV，RBC計(jì)數(shù)和HB都反映了紅細(xì)胞質(zhì)量，并且這三個(gè)參數(shù)之間通常具有相關(guān)性，所以簡(jiǎn)單的測(cè)定PCV值即是一個(gè)良好的臨床指征。PCV值通常被用于描述貧血的嚴(yán)重程度。犬PCV近似參考值：輕度貧血30-36%，中度貧血18-29%，重度貧血<

4、18%。貓PCV近似參考值：輕度貧血20-24%，中度貧血15-19%，重度貧血<14%。 紅細(xì)胞指數(shù)紅細(xì)胞指數(shù)由紅細(xì)胞的各項(xiàng)參數(shù)計(jì)算得出，它有效提供了紅細(xì)胞的大小和血紅蛋白濃度的數(shù)據(jù)。平均紅細(xì)胞容積（MCV）表示單個(gè)紅細(xì)胞的體積，MCV計(jì)算公式：PCV × 10RBC ×1012/lMCV記錄單位是“毫微微升”（fl），當(dāng)其數(shù)值上升時(shí)，預(yù)示“大紅細(xì)胞癥”，其數(shù)值下降時(shí)，預(yù)示“小紅細(xì)胞癥”。當(dāng)血液樣本被冷藏或郵寄至實(shí)驗(yàn)室時(shí)，MCV數(shù)值可能會(huì)被人為升高。大紅細(xì)胞癥也見于再生性貧血反應(yīng)、葉酸缺乏、造血功能異常和部分FeLV（貓白血病病毒）感染病例。小紅細(xì)胞癥是某些犬種（如

5、日本秋田犬，沙皮犬，柴犬）的正?，F(xiàn)象，也可能是缺鐵反應(yīng)或肝門靜脈短路癥。平均紅細(xì)胞血紅蛋白含量（MCH）是指單個(gè)紅細(xì)胞中所含的血紅蛋白量，單位是皮克（pg）。MCH計(jì)算公式：Hb × 10 RBC ×1012/lMCH值上升時(shí)，預(yù)示紅細(xì)胞著色加深；其值下降時(shí)，預(yù)示紅細(xì)胞著色變淺（最常見的原因是鐵元素缺乏）。平均紅細(xì)胞血紅蛋白濃度（MCHC）指血紅蛋白在總紅細(xì)胞數(shù)量中所占的百分比（單位 g/dl）， MCHC計(jì)算公式：Hb × 100PCV僅當(dāng)MCHC值下降時(shí)才具有臨床意義，因?yàn)樵谏韺W(xué)中并不存在MCHC值升高的現(xiàn)象。MCH值升高的原因是與紅細(xì)胞破裂、脂血癥或出現(xiàn)海

6、因茨小體有關(guān)的人為因素。 血涂片制備一張優(yōu)質(zhì)血涂片對(duì)于貧血的診斷非常有必要。 通常將一滴用EDTA處理的血液滴在載玻片上，用另一塊載玻片連續(xù)而流暢地向前推動(dòng)，涂片的尾部會(huì)出現(xiàn)“羽毛狀的邊緣”。血涂片經(jīng)空氣干燥后用diff-quik染色。在血涂片的羽毛狀尾部，血細(xì)胞呈單層分布，這個(gè)區(qū)域適合在低倍和高倍鏡下進(jìn)行系統(tǒng)觀測(cè)。所有細(xì)胞譜都應(yīng)被評(píng)定。 紅細(xì)胞形態(tài)學(xué)正常的紅細(xì)胞呈“兩面凹陷的圓盤狀”，中間為淺著色區(qū)。犬紅細(xì)胞直徑大約為7mm，貓紅細(xì)胞直徑稍?。? mm)。臨床上可觀察到一系列紅細(xì)胞形態(tài)學(xué)變化，在評(píng)估血涂片的基礎(chǔ)上對(duì)此鑒別很重要， 因?yàn)樗鼈兲峁┝吮匾脑\斷信息。 錢串紅細(xì)胞 在纖維蛋白原濃度升

7、高或球蛋白變性的高蛋白血漿中，紅細(xì)胞常常堆砌在一起，形如一串錢幣。這種現(xiàn)象在馬的血液中屬正常，在貓的血液中偶見。在犬上，錢串紅細(xì)胞通常發(fā)生在炎癥或腫瘤疾病中。在紅細(xì)胞凝集（見下文）的情況下，鑒別錢串紅細(xì)胞的結(jié)構(gòu)很重要。 紅細(xì)胞凝集紅細(xì)胞凝集指紅細(xì)胞的聚集（葡萄串狀），這種情況也許可在EDTA處理的抗凝血中肉眼可見或通過(guò)鏡檢發(fā)現(xiàn)。紅細(xì)胞凝集由抗體（通常為IgM）介導(dǎo)，并且強(qiáng)有力的指示了免疫介導(dǎo)的溶血性貧血。 紅細(xì)胞大小不均等癥紅細(xì)胞大小不均等癥簡(jiǎn)單說(shuō)來(lái)就是出現(xiàn)了紅細(xì)胞大小不一的變化，正常血細(xì)胞中混有大紅細(xì)胞或小紅細(xì)胞。大紅細(xì)胞通常呈多染色性，并且可能屬于網(wǎng)織紅細(xì)胞。小紅細(xì)胞是缺鐵性貧血的特征，在

8、球形紅細(xì)胞癥中（見下文），紅細(xì)胞也比正常時(shí)小。 紅細(xì)胞多染色性紅細(xì)胞多染色性是指紅細(xì)胞染色性質(zhì)的變異，通常出現(xiàn)淺藍(lán)色的染色特征。這些細(xì)胞通常為大紅細(xì)胞，并且可能是網(wǎng)織紅細(xì)胞。紅細(xì)胞多染色性伴隨MCV值上升時(shí)，強(qiáng)烈提示再生性貧血反應(yīng)。紅細(xì)胞低染紅細(xì)胞低染在鏡下可見到紅細(xì)胞中央的淺著色區(qū)擴(kuò)大，這正如缺鐵性貧血中可見的血紅蛋白濃度降低。 異形紅細(xì)胞癥異形紅細(xì)胞癥簡(jiǎn)單說(shuō)來(lái)就是紅細(xì)胞的形狀發(fā)生了異常變化。 球形紅細(xì)胞癥球形紅細(xì)胞指小而圓，深染且中央淺著色區(qū)消失的紅細(xì)胞。球形紅細(xì)胞是被部分吞噬的紅細(xì)胞：被抗體（和補(bǔ)體）結(jié)合的紅細(xì)胞通過(guò)肝臟或脾臟時(shí)，附近的吞噬細(xì)胞移除了一部分的紅細(xì)胞膜。紅細(xì)胞能“自我修復(fù)”

9、，并且繼續(xù)以體積變小的紅細(xì)胞存在于循環(huán)血液當(dāng)中。球形紅細(xì)胞指示抗體的出現(xiàn)，但是卻不能辨別免疫介導(dǎo)性溶血癥是原發(fā)性，或是繼發(fā)性。偶爾情況下，球形紅細(xì)胞可能形成于非免疫介導(dǎo)性血管疾病。同時(shí)，球形紅細(xì)胞在犬上易見。但貓的紅細(xì)胞正常時(shí)體積偏小，所以不能確實(shí)分辨球形細(xì)胞。 裂紅細(xì)胞裂紅細(xì)胞是伴隨著紅細(xì)胞外傷性裂解產(chǎn)生的細(xì)胞碎片。這種情況等同于出現(xiàn)了血管內(nèi)阻塞（例如寄生蟲或血栓），這通常也是犬脾臟血管肉瘤的臨床特征。裂紅細(xì)胞也可見于血管內(nèi)彌漫性凝血（DIC）、充血性心力衰竭、淋巴瘤或腎小球性腎炎的情況。棘紅細(xì)胞棘紅細(xì)胞表示紅細(xì)胞表面不同位置出現(xiàn)不同長(zhǎng)度的突起。棘紅細(xì)胞可能形成于紅細(xì)胞膜的膽固醇或磷脂異常，

10、也可能是紅細(xì)胞的機(jī)械性損傷（例如DIC或血管肉瘤），偶見于淋巴瘤、肝臟疾病、脾功能亢進(jìn)或腎小球性腎炎。 鋸齒狀紅細(xì)胞鋸齒狀紅細(xì)胞表示紅細(xì)胞表面出現(xiàn)大面積短而平滑的突起。通常是人為因素導(dǎo)致，預(yù)示EDTA過(guò)量（當(dāng)采血量沒(méi)有達(dá)到采血管的標(biāo)注容量時(shí)），但也偶見于新陳代謝異常（例如丙酮激酸酶缺乏）或腎臟疾病。 嗜堿性彩斑嗜堿性彩斑指示有RNA的殘留物，在牛的血液中屬正常，偶見于貓的貧血病例。這也是犬鉛中毒的特征（鉛通過(guò)破壞亞鐵血紅素和球蛋白合成，從而妨礙紅細(xì)胞生成） 豪威爾氏體豪威爾氏體是細(xì)胞核的殘留物，在正常的貓血液中可見，或見于對(duì)貧血的應(yīng)答反應(yīng)中。豪威爾氏體也可在脾切除的動(dòng)物血液中見到。 海因茨小體

11、海因茨小體是出現(xiàn)在紅細(xì)胞膜表面的變性血紅蛋白聚集物，最佳觀測(cè)方式是配合使用活體染色劑觀察（Leishmans染色或新亞甲基藍(lán)染色）。正常貓血液中大約有5-10%的紅細(xì)胞含有海因茨小體。當(dāng)發(fā)生嚴(yán)重的氧化損傷時(shí)，可能會(huì)出現(xiàn)相關(guān)的偏心細(xì)胞。有核紅細(xì)胞 有核紅細(xì)胞并不存于正常血液中，但在再生障礙性貧血中常見，隨著對(duì)紅細(xì)胞需求的增加，可從髓內(nèi)或髓外的造血機(jī)制中被釋放出來(lái)。輕度骨髓基質(zhì)損傷時(shí)也可能允許釋放有核紅細(xì)胞。健康的小型雪納瑞犬和臘腸犬的循環(huán)血液中也可見一些有核紅細(xì)胞。紅細(xì)胞寄生蟲在血涂片檢查中，可能發(fā)現(xiàn)一系列紅細(xì)胞相關(guān)的病原生物。在高寄生蟲血癥時(shí)，大體型犬巴貝斯蟲尤其容易被發(fā)現(xiàn)。小體型犬巴貝斯蟲和

12、表面支原體（血液支原體）通常難以發(fā)現(xiàn)，PCR實(shí)驗(yàn)對(duì)確診此類感染具有高度敏感性。 血小板評(píng)估血涂片用于血小板評(píng)估比較準(zhǔn)確，因?yàn)榇蟛糠值淖詣?dòng)儀器會(huì)對(duì)血小板凝集效應(yīng)的計(jì)數(shù)不準(zhǔn)。在血涂片中（通常在邊緣部分）可見血小板凝集，這也預(yù)示著假性機(jī)器低讀數(shù)。貓的紅細(xì)胞與血小板在體積上相似，這也加大了機(jī)器讀數(shù)的誤差。血小板減少癥需要用血涂片計(jì)算平均血小板值來(lái)判定：在100倍鏡下（油鏡頭，即最終放大率為1000倍），取10個(gè)視野計(jì)數(shù)的平均值。貓：平均血小板值×20=血小板數(shù)×109/l 犬：平均血小板值×15=血小板數(shù)×109/l 白細(xì)胞評(píng)估血涂片常用于手工白細(xì)胞分類計(jì)數(shù)，通

13、過(guò)測(cè)定一定數(shù)目白細(xì)胞內(nèi)的各譜系細(xì)胞百分比來(lái)確定。通過(guò)血液分析儀或用血細(xì)胞計(jì)數(shù)板手工計(jì)數(shù)后，各白細(xì)胞百分比數(shù)值需轉(zhuǎn)化為絕對(duì)值來(lái)表示結(jié)果(×109/l)。 白細(xì)胞計(jì)數(shù)近似值，也可以通過(guò)鏡下評(píng)估血涂片得出。平均白細(xì)胞計(jì)數(shù)方法：40倍物鏡下，取10個(gè)視野中的平均計(jì)數(shù)值（即在10倍目鏡下獲得400倍的放大率），乘以1500，等于白細(xì)胞數(shù)×109/l。白細(xì)胞形態(tài)學(xué)異常也要檢查，同時(shí)要評(píng)估桿狀或早期粒細(xì)胞所占比例。白細(xì)胞中的中毒顆粒物和空泡，以及非典型單核細(xì)胞的出現(xiàn)，這些也要熟悉判定。 網(wǎng)織紅細(xì)胞計(jì)數(shù)網(wǎng)織紅細(xì)胞計(jì)數(shù)對(duì)確診再生性貧血反應(yīng)是最為準(zhǔn)確的。在犬貓臨床上，網(wǎng)織紅細(xì)胞過(guò)多癥與紅細(xì)胞多

14、染性存在普遍關(guān)聯(lián)。網(wǎng)織紅細(xì)胞僅能夠通過(guò)活體染色法（例如新甲基藍(lán)或亮甲酚藍(lán)）來(lái)辨別，這時(shí)聚集的核糖體RNA顯露。網(wǎng)織紅細(xì)胞在形態(tài)學(xué)上分集結(jié)狀或點(diǎn)狀。犬僅存在集結(jié)狀網(wǎng)織紅細(xì)胞，但貓二者都有。在犬上，網(wǎng)織紅細(xì)胞百分比（在紅細(xì)胞中）需要表示為絕對(duì)值(×109/l)。網(wǎng)織紅細(xì)胞計(jì)數(shù)>60 ×109/l是再生性貧血反應(yīng)的象征，>400 ×109/表示顯著的再生。作為另外一個(gè)選擇，網(wǎng)織紅細(xì)胞生成指數(shù)（RPI）也可能需要確定。RPI對(duì)“校正”貧血程度的評(píng)估和網(wǎng)織紅細(xì)胞壽命有重要價(jià)值。1）貧血程度校正校正值%（或計(jì)數(shù)值）=絕對(duì)值%（或計(jì)數(shù)值）× PCV值/正常

15、PCV值 (45)2）網(wǎng)織紅細(xì)胞壽命校正RPI = 校正值 % × 1/血液成熟時(shí)間血液成熟時(shí)間取決于PCV值：PCV 45% 1 天 35% 1.5 天 25% 2 天 15% 2.5 天RPI >2.5時(shí)，表示再生性貧血反應(yīng)。 貓集結(jié)狀網(wǎng)織紅細(xì)胞最初從骨髓中被釋放，在經(jīng)過(guò)10-12天的成熟期后，轉(zhuǎn)變?yōu)辄c(diǎn)狀網(wǎng)織紅細(xì)胞。 相比之下，點(diǎn)狀網(wǎng)織紅細(xì)胞在循環(huán)血液中出現(xiàn)需要3-4周。在貓上，集結(jié)狀網(wǎng)織紅細(xì)胞計(jì)數(shù)可判定再生性貧血，它反映骨髓再生活躍程度，而點(diǎn)狀紅細(xì)胞計(jì)數(shù)代表累積再生貧血。集結(jié)狀紅細(xì)胞計(jì)數(shù)>40 ×109/l表示再生性貧血，>200 ×109

16、/l時(shí)表示顯著再生性貧血。 骨髓評(píng)估對(duì)于非再生性貧血的病例，骨髓評(píng)估是診斷過(guò)程的一個(gè)重要步驟?？赡苄枰杉瘍煞N樣本：抽取骨髓內(nèi)容物或用骨髓針穿刺活檢。前一種樣本給臨床病理學(xué)專家分析，而后一種樣本給組織病理學(xué)專家分析。骨髓穿刺針的優(yōu)點(diǎn)是病理組織可得到更好的評(píng)估，但要獲得優(yōu)質(zhì)的穿刺活檢物卻具有挑戰(zhàn)性。將穿刺活檢物放入福爾馬林溶液固定之前先做壓片。通常在股骨干骨（貓）或髂骨嵴（犬）來(lái)獲得樣本。在大型犬，肋骨或胸骨節(jié)是骨髓抽取的備用位置。抽取的骨髓樣本應(yīng)放入EDTA或ACD（可從采血袋中獲得）抗凝血?jiǎng)┲斜４?，同時(shí)至少要制備10張壓片，迅速空氣干燥后染色。主要的譜系細(xì)胞應(yīng)該按照成熟程度、所占的相對(duì)比例、

17、粒細(xì)胞和紅細(xì)胞比例的順序依次確定。同時(shí)應(yīng)該檢測(cè)異常細(xì)胞（腫瘤細(xì)胞）。 LECTURE 2. LABORATORY DIAGNOSIS OF ANAEMIA INTRODUCTIONThe anaemic patient cannot be successfully diagnosed and managed without at least some level of laboratory testing. This may be undertaken in-practice or by sending EDTA anticoagulated blood to a commercial dia

18、gnostic laboratory. The minimum in-practice equipment required for basic haematological analysis would be a microhaematocrit centrifuge and tube reader, materials for preparation of a stained blood smear and a microscope for evaluation of the blood smear. A refractometer for assessment of plasma pro

19、teins is also valuable. Increasingly sophisticated instrumentation is now available for in-practice laboratories to undertake haematological analysis. Most of these machines produce acceptable data for red and white blood cells but may underestimate platelets. It is essential to examine a blood smea

20、r in parallel with assessing the readings from such equipment. This lecture reviews the erythrocyte parameters and cytological changes that may be seen on examination of the blood smear. ERYTHROCYTE PARAMETERSTotal red blood cell count, PCV and HbThe packed cell volume (PCV) is the percentage of blo

21、od volume made up of red blood cells (RBCs). It is determined manually by centrifugation of a microhaematocrit tube and recorded as a percentage of blood volume. The haematocrit (Hct) is determined by the automated haematology analyser on the basis of cell size and number. The total RBC count is det

22、ermined in automated fashion or may be measured manually using a haemocytometer chamber and microscope. This parameter is recorded as RBC ×1012/l. The concentration of haemoglobin (Hb) in the blood is also determined in automated fashion and reported as g/dl. Determination of Hb concentration w

23、ill be affected by the presence of lipaemia, haemolysis or bilirubin in the blood sample. A simple check for accuracy is that the Hb × 3 should equal the haematocrit. These values are assessed relative to a normal reference range but it should be remembered that these reference ranges may not a

24、pply to all situations. For example very young animals or pregnant animals may have outlying values and there are some breed-related effects (e.g. sight hounds have relatively high PCV and lower neutrophil count). The PCV, RBC count and Hb all reflect the red cell mass and these three parameters gen

25、erally correlate, so simple PCV measurement is a good index to use. The PCV may be used to describe the severity of anaemia. As an approximation a dog has a mild anaemia with a PCV of 30 36%, moderate anaemia at 18 29% and severe anaemia at <18%. A cat has mild anaemia at 20 24%, moderate anaemia

26、 at 15 19% and severe anaemia at <14%. Erythrocyte indicesThe erythrocyte indices are derived from the parameters above and provide a useful assessment of the size and haemoglobin concentration of the erythrocytes. The mean corpuscular (cellular) volume (MCV) indicates the size of individual RBCs

27、 and is calculated by the formula:PCV × 10RBC ×1012/lThe MCV is recorded as femtolitres (fl) and an elevation indicates macrocytosis whilst reduction indicates microcytosis. The MCV may artefactually elevate when a blood sample is stored or when samples are sent to a laboratory by post. Ma

28、crocytosis also occurs with a regenerative response or in folate deficiency, dyserythropoiesis and some cases of FeLV infection. Microcytosis may be a normal feature in some canine breeds (akita, shar pei, shiba inu) or reflect iron deficiency or portosystemic shunt. The mean corpuscular haemoglobin

29、 (MCH) indicates the mass of Hb in each individual RBC in picograms (pg). MCH is calculated by the formula:Hb × 10 RBC ×1012/lAn increase in MCH indicates hyperchromasia and a decrease indicates hypochromasia (most often due to iron deficiency). The mean corpuscular haemoglobin concentrati

30、on (MCHC) indicates the percentage of the entire RBC mass that is composed of Hb (in g/dl) and is calculated using the formula:Hb × 100PCVOnly a reduced MCHC is of meaning as it is physiologically impossible for there to be an elevation in MCHC. Elevated MCHC is an artifact due to haemolysis, l

31、ipaemia or the presence of Heinz bodies. THE BLOOD SMEARPreparation of a good blood smear is essential to diagnostic haematology. A spreader slide is used to smoothly smear a drop of EDTA blood such that the resultant smear has a good feather edge. The smear is air-dried and stained by Diff-Quik. Th

32、e monolayer of the smear, behind the feather edge should be evaluated at both low and high magnifications in a systematic fashion. All lineages should be assessed. ERYTHROCYTE MORPHOLOGYThe normal RBC is a biconcave disc with a zone of central pallor. Canine RBCs are approximately 7 mm in diameter a

33、nd feline RBCs are smaller (6 mm). A range of morphological changes is recognized and it is important to identify these on evaluation of the blood smear as they provide essential diagnostic information. RouleauxIn hyperproteinaemic plasma with elevated concentration of fibrinogen or altered nature o

34、f globulins the erythrocytes often stack together like a role of coins. This can be a normal feature of equine blood and may occasionally be seen in normal cats. In the dog, rouleaux formation often occurs in inflammatory or neoplastic disease. It is important to distinguish rouleaux formation from

35、agglutination (see below). AgglutinationAgglutination is aggregation of erythrocytes (like a bunch of grapes) that may be observed macroscopically in the EDTA blood sample or microscopically. Agglutination is mediated by antibody (generally IgM) and is strongly indicative of an immune-mediated haemo

36、lytic anaemia. AnisocytosisAnisocytosis simply means variation in the size of erythrocytes such that there is a mixture of normal cells with microcytes or macrocytes. Macrocytic cells are often polychromatic and likely to be reticulocytes. Microcytic cells characterize iron deficiency anaemia and sp

37、herocytes (see below) are also smaller than normal. PolychromasiaPolychromasia is variation in the colouration of erythrocytes but generally refers to the presence of cells with a pale blue colouration. These cells are also often macrocytic and are likely to represent reticulocytes. Polychromasia wi

38、th elevated MCV is strongly suggestive of a regenerative response. HypochromasiaHypochromasia is seen as an increase in the zone of central pallor and indicates a reduction in Hb concentration as would be seen in iron deficiency anaemia. PoikilocytosisPoikilocytosis simply means a variation in the s

39、hape of the red cells. SpherocytosisA spherocyte is a smaller, rounder, more darkly stained red cell that lacks a central zone of pallor. A spherocyte is a partially phagocytosed red cell that is formed when an antibody (and complement) coated RBC passes through the spleen or liver and a nearby macr

40、ophage removes a portion of the cell membrane. The cell is able to repair itself and continue in the circulating blood as an erythrocyte of reduced volume. Spherocytosis indicates the presence of antibody but does not discriminate between a primary and secondary immune-mediated haemolysis. Occasiona

41、lly some spherocytes may form with vascular disease due to non-immune-mediated damage. Whilst spherocytes may be readily detected in the dog, the normally small size of feline erythrocytes means that it is not possible to reliably define these cells in the cat. SchistocytosisA schistocyte is a red c

42、ell fragment that appears following traumatic disruption of the red cell. This often equates to the presence of intravascular obstructions (e.g. parasites or thrombi) and is a common feature in canine splenic haemangiosarcoma. Schistocytes may also occur in disseminated intravascular coagulation (DI

43、C) or in congestive heart failure, lymphoma or glomerulonephritis. AcanthocytesAre spiculated red cells with membrane projections of varying length and position. These cells may form when there is abnormality of cholesterol or phospholipid of the cell membrane or where there is mechanical damage (e.

44、g. DIC, haemangiosarcoma) or occasionally with lymphoma, liver disease, hypersplenism or glomerulonephritis. EchinocytesAre spiculated cells with short and evenly spaced membrane projections. These are generally an artifact and indicate an excess of EDTA (when the blood tube was not optimally filled

45、) but may occasionally occur in metabolic (e.g. PK deficiency) or renal disease. Basophilic stipplingThis indicates the presence of residual RNA and is a relatively common feature in cattle and occasionally observed in anaemic cats. It is also a feature of lead toxicity in the dog (lead interferes w

46、ith erythropoiesis by disrupting heme and globin synthesis). Howell-Jolly bodiesHowell-Jolly bodies are nuclear remnants that may be normal in the cat or occur in response to anaemia. They may also be seen in splenectomized animals. Heinz bodiesHeinz bodies are aggregates of denatured haemoglobin th

47、at associate with the cell membrane and are best demonstrated with supravital stains (Leishmans stain or new methylene blue). Up to 5 10% of normal feline red cells may have Heinz bodies. The related eccentrocyte may occur with severe oxidation. Nucleated erythrocytesNucleated erythrocytes are not s

48、een in normal blood but in markedly regenerative anaemias with demand for erythrocytes may be released from the bone marrow or sites or extramedullary haematopoiesis. Mild bone marrow stromal damage may also permit release of nucleated RBCs. Healthy miniature schnauzers and dachshunds may also have

49、some nucleated RBCs in the circulation. Erythrocyte parasitesA range of red cell-associated organisms may be detected on evaluation of the blood smear. In particular the large form Babesia is readily detected if there is high parasitaemia. Small form Babesia and the surface Mycoplasma (haemoplasmas)

50、 are often difficult to discern and PCR testing remains the most sensitive means of confirming these infections. Evaluation of plateletsThe smear should always be assessed for platelets as most automated machines do not provide accurate platelet counts when these cells aggregate. Aggregated platelet

51、s may be seen in the smear (often towards the edges) and will indicate whether there is a falsely low machine reading. In cats, there is overlap in size of platelets and red cells providing further inaccuracy. Thrombocytopenia may be assessed from the blood smear by counting the mean number of plate

52、lets in ten ×100 (oil immersion) fields (i.e. final magnification of ×1000). For cats the mean number × 20 = platelets ×109/l and for dogs the mean number × 15 = platelets ×109/l. Evaluation of leucocytesThe blood smear may be used to manually calculate the differential

53、 leucocyte count by determining the percentage of cells of each lineage after counting a set number of leucocytes. These percentages should always be converted to absolute numbers using the total white cell count (×109/l) as determined by the haematology analyser or manually with a haemocytomet

54、er chamber. An approximation of leucocyte number may also be determined by evaluation of the blood smear. The mean number of leucocytes in ten fields counted with the x40 objective of the microscope (i.e. magnification of ×400 with ×10 eyepiece) multiplied by 1500 gives the total WBC in &#

55、215;109/l. Morphological abnormalities in leucocytes should also be assessed. The proportion of band or earlier granulocytes should be assessed. The presence of toxic granulation or vacuolation of granulocytes or the presence of atypical mononuclear cells is readily determined. THE RETICULOCYTE COUN

56、TA reticulocyte count is the most accurate means of determining the presence of a regenerative response. There is a good general correlation between reticulocytosis and polychromasia in the dog and cat. Reticulocytes can only be identified by supravital staining (e.g. new methylene blue or brilliant

57、 cresyl green) to demonstrate aggregated ribosomal RNA. Reticulocytes may aggregate or punctate in morphology. In the dog only aggregate reticulocytes occur but both forms are recognized in the cat. In the dog the percentage reticulocytes (of red cells) should be expressed as an absolute number (

58、15;109/l). A reticulocyte count of >60 ×109/l is indicative of a regenerative response and a count of >400 ×109/l indicates marked regeneration. Alternatively, the reticulocyte production index (RPI) may be determined. The RPI corrects the count for the degree of anaemia and the lifespan of the reticulocyte. The first correction is for degree of anaemia that is