From pmcmanus@vet.upenn.edu Fri Feb 20 07:59:15 1998 Date: Thu, 19 Feb 1998 21:17:05 -0500 (EST) From: Patricia McManus To: Hillary Gorman Subject: CLM objectives for final exam Resent-Date: Fri, 20 Feb 1998 07:58:04 -0500 (EST) Resent-From: Hillary Gorman Resent-To: hillary@izzy.com Hillary, Since you have ready access to the internet, and place your notes there, I thought I would 'use' you to transmit this to your classmates. You can add it into your CLM notes. I would think having it available on computer may help in a review. I will also be providing a paper copy in class, hopefully Friday, but certainly by Monday, the 23rd. I am sending it as an attachment as well, but it might not be useful if we are not 'compatible'. Thank you, Dr. M. Study Objectives for Cytology, Erythrocyte and Leukocyte Sections of Clinical Laboratory Medicine Course Dr. P. McManus pmcmanus@vet.upenn.edu The student will be able to. . . Discuss advantages and disadvantages of cytologic evaluation. Describe key features that distinguish three general tumor types, i.e., spindle cell, epithelial, and round cell neoplasia. Cite at least two examples of each tumor type. List morphologic features which fit the cytologic criteria of malignancy. Discuss key differences between pure transudates, modified transudates, and inflammatory exudates. Cite at least two causes for each. Describe key features that characterize a chylous effusion and list at least two possible causes. Cite the most important function of red blood cells and discuss how compromise of this function in anemic animals translates into clinical signs. Describe morphologic/structural changes seen in maturation of erythroid precursors within marrow. Cite the stimulus for heightened erythropoietin production by the kidney (i.e., hypoxemia). Cite which animals have long-lived RBCs and generally lack reticulocytosis in response to blood loss or hemolysis. List the three most important functions of erythrocyte metabolism (specific pathway names are not needed). Describe how iron is assessed animals, specifically addressing the following means: marrow hemosiderin; serum iron; serum ferritin. Cite which species normally does not contain stainable iron in its marrow and list three possible causes for seeing abnormal stainable iron in this species. Explain the relationship between tissue ferritin and serum ferritin. Cite what horses and Akita and Shiba dogs have in common in regard to RBC's electrolyte content and why this piece of apparent trivia is important to remember. Define the terms: anemia; methemoglobinemia; erythrocytosis; non-regenerative anemia; regenerative anemia. List two general causes for regenerative anemia, e.g., blood loss; hemolysis. List four specific causes for hemolysis, e.g., IMHA, Hemobartonellosis, onions, etc. List five causes for non-regenerative anemia, e.g., hypothyroidism, neoplasia, etc. Cite units for all CBC values: examples - MCV- fL; MCHC- gm/dl; RBC count- millions/microliter; WBC- thousands/microliter. Explain how RBCs are counted via an impedance counter and why high WBCs and low RBCs can lead to erroneous counts and indices. Explain the difference between a PCV and a hematocrit. Define MCV and MCHC and be able to determine these values if given the RBC count, hemoglobin, and PCV. Define: RDW; homogeneous RBC population; heterogeneous RBC population; anisocytosis; poikilocytosis; hypochromic; normochromic; microcytic; macrocytic; normocytic. Cite two possible causes for microcytosis and two possible causes for macrocytosis. Be able to identify the following in a kodachrome and describe at least one possible disease association: acanthocyte; elliptocyte; keratocyte; blister cell; schistocyte; eccentrocyte; Heinz bodies; spherocytes; Howell Jolly bodies. Given a reticulocyte percent and RBC count, be able to determine an absolute reticulocyte count. Define regenerative anemia by the absolute reticulocyte count (i.e., >70,000/microliter). Explain when a 'corrected reticulocyte count' may be useful and describe how it is determined. Describe the key differences between intravascular and extravascular hemolysis and cite at lease one example of each. Describe how total protein (TP) can be useful in distinguishing blood loss from hemolysis as causes for regenerative anemias. Explain the differences between the various types of erythrocytoses, i.e., relative, absolute, and transient. Discuss indications for determining a white blood cell count. Explain the difference between a WIC and a WOC; explain how optical counts can determine a leukocyte differential as well as a total WBC. Be able to determine absolute leukocyte counts if given the total WBC count and relative differential. Explain why it is important to determine absolute counts versus relative counts. Be able to identify the following in a kodachrome: neutrophil; lymphocyte; monocyte; basophil; eosinophil; plasma cell; mast cell. Discuss the significance of increases or decreases for EACH cell type in peripheral blood. Describe morphology of a neutrophil displaying toxic change. Explain the difference between a degenerate neutrophil and a toxic neutrophil. Be able to determine a PCV using a ruler. Be able to determine the total WBC count if provided with the number of leukocytes observed within 9 large squares of a hemocytometer. Be able to correct a total WBC count for nucleated RBCs if provided with the tWBC and nRBC count/100 WBCs. Explain how to assess platelet adequacy in a blood smear. Describe the three functional compartments of the marrow and the two functional compartments of blood. Explain how these compartments can contribute to changes in neutrophil counts. Compare and contrast the following: physiologic leukocytosis; stress leukogram; inflammatory leukogram. Explain the potential significance of detecting a left-shift and toxic change in neutrophils in a peripheral blood smear. Define: chronic lymphoid leukemia; acute lymphoid leukemia; leukemoid reaction; Pelger-Huet anomaly; chronic myeloproliferative disease; acute myeloid leukemia. Be able to locate neutrophils, lymphocytes, monocytes, and eosinophils in scatterplots generated by a Cell-Dyn 3500 hematology analyzer. [Part 2, Application/MAC-BINHEX40 20KB] [Unable to print this part] [ Part 3: "Attached Text" ] Patricia M. McManus, V.M.D., Ph.D. Diplomate ACVP Assistant Professor of Clinical Pathology Laboratory of Pathology School of Veterinary Medicine University of Pennsylvania 3800 Spruce Street Philadelphia, PA 19104 Phone: 215-573-9588; Fax: 215-898-0719 email: pmcmanus@vet.upenn.edu