DSH cat (11 y-old-castrated)
History : Recheck anemia
Pt : 7.1 (5.6-7.4)
HCt : 9 (25-46)
RBC: 1.5 (5.3-10.2)
MCV: 59 (42-53)
MCHC 35.7 (33.7-37.5)
RDW: 59.7 (16-21)
Retic % : 3
REtic absolute: 45 ( <50)
Plt-instrument - 40
plt-hand count - 152
Macros - plt Many ; no clumps.
total Leu : 2.3 (4-14.5)
nRBC:1/100 WBCs
Seg: 58%
absolute : 1.3 (3-9.2)
Lym : 36
absolute : 0.8 ( 0.9-3.9)
Mono : 2 %
absolute: 0.0 (0-.5)
Eos : 4 %
absolute : 0.1 (0-1.2)
Moderate anisocytosis, slight polychromasia, slight poikilocytosis
Occasional spherocytes.
Occasional HJ bodies
Rare Heinz bodies ( within normal limits)
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說說想法吧
4 則留言:
Pt : 7.1 (5.6-7.4)
HCt : 9 (25-46)
RBC: 1.5 (5.3-10.2)
MCV: 59 (42-53)
MCHC 35.7 (33.7-37.5)
--Macrocytic , monochromic anemia (kind of severe anemia…PCV 9%)
RDW: 59.7 (16-21)
--Increasing RDW is resulted from anemia with increased MCV
Retic % : 3
REtic absolute: 45 ( <50)
--Normal healthy cat can have small numbers of reticulocyte (up to 0.4%?). In anemic animal the reticulocyte are mixed with fewer mature erythrocytes, so the relative high percentage of reticulocyte is not necessarily actual bone marrow response to the anemia.
--Anemia with not significantly increased reticulocyte I say it’s non-regenerative anemia.
Plt-instrument - 40
plt-hand count – 152
Macros - plt Many ; no clumps.
--I guess Plt is within normal limit
total Leu : 2.3 (4-14.5)
nRBC:1/100 WBCs
Seg: 58%
absolute : 1.3 (3-9.2)
Lym : 36
absolute : 0.8 ( 0.9-3.9)
Mono : 2 %
absolute: 0.0 (0-.5)
Eos : 4 %
absolute : 0.1 (0-1.2)
--Mild leucopenia, neutropenia
Moderate anisocytosis, slight polychromasia, slight poikilocytosis
Occasional spherocytes.
Occasional HJ bodies
Rare Heinz bodies ( within normal limits)
--Anisocytosis could be related to macrocytosis.
--Polychromatic erythrocytes usually refer to reticulocytes. The slight polychromasia in this case probably is more because of the severe anemia than truly increased reticulicytes.
--Poikilocytosis could be artificial resulted from the time lag between sample collection and analysis.
--Occasional spherocytes and HJ body probably are not clinically significant.
For this specific macrocytic, nonregenerative anemic and leukopenic cat, I think FeLV –associated nonregenative anemia is on the top of the differential diagnosis list.
我是外行 這些是臨時翻書寫的
不過我想我寫錯了被指正才能真的學到東西
希望可以聽聽版主專家的看法囉
1 提點 RDW 是否合於常理?
2.什麼造成hand count vs 機器count的血小板差異?
3. 血片smear上, 紅血球一點都不大,也就是沒有macrocytic 的狀況。
我們使用的機器是Cell-Dye，紅血球和血小板的方式是用大小區分的，但是貓貓的血小板和RBC有時候差異不大，很難分開，如果有很多thrombocytosis + marked 貧血的話，很多大血小板就會被算成紅血球，這種狀況就會發現圖上會有兩個peak,較低的那個peak是macro-plt.RDW會falsely增加，MCV會falsely降低，血小板也會下降，這是機器的限制，因此即使有機器，學會看血片的基本工還是必要的喔!!!因為看到disagree的部分就要想想是否有問題。
所以此case plt是以手算的為準囉,MCV是正常或偏低,應是non-regenerative anemia,且有骨髓抑制情形,pancytopenia,
不知anemia原因是甚麼? hct only 9! blood parasites or IMHA?
常在臨床碰到無人可討論狀況,偶然發現您的blog覺得很棒,邏輯很清楚,謝謝您的分享!
可問一個問題? cbc在此case的plt有極限,那如果用QBC(ex idexx)plt 誤差會不會比較小??
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