Tam Kan Saym (Hemogram) & Kan Biyokimyas

mmunite
Spesifik Non spesifik

mmunospesifik
B lenfosit T lenfosit

Fagositik
Granlositler Monosit / Makrofaj

Lkositler

Sirklasyondaki beyaz kan hcreleri

Fagositik sistem (phagocytic) non spesifik

Granulositler Monosit / Makrofaj T lenfositler Humoral immunite (antikor) B lenfositler Hcresel immunite (antijen)

mmunositik sistem (Immunocytic) - spesifik

Fagositik sistem

I. Chemotaxis kk molekller

Lipopolisakkaritler Aktif komplement paralar Antijen-Antikor kompleksi Baz lenfosit rnleri

II. Adherence yapma III. nternalizasyon Yok etmek, absorbe

Granulositler

Ntrofiller Eozinofiller Bazofiller

Granulositler

Ntrofiller

Derin boyanm kromotin olgun ntrofiller ki granl

Spesifik Bakteri ldrcler

Laktoferrin, katiyonik proteinler Digestif enzimler

Lizozom l organizmay zmek

mrleri saatler ve gn ile snrl Salg yapc zellikleri

Granulositler

Ntrofiller

Salg yapc zellikleri

Prostoglandinler, komplement paralar, biolojik aktif aminler Bu zellikleri Lokal ve sistemik inflamator cevap oluturucu

Kedi ve kpeklerde 3000 12000/mikrolitre Olgunlamam ntrofiller

Periferdeki lkositler normalken 300/mikrolitre

Granulositler

Ntrofiller

Neutropenia, Neutrophilia

nflamatory hastalklarda nemli Klinik olarak ok nemli

Olgunlamam ntrofillerdeki relatif art = Left shift

Kemik iliinde retilirler Sirklasyona girerler Kan damarlarnn duvarlarnda toplanrlar Dokulara geerler

Granulositler

Ntrofiller

Neutropenia, Neutrophilia

nflamatory hastalklarda nemli Klinik olarak ok nemli

Olgunlamam ntrofillerdeki relatif art = Left shift

Kemik iliinde retilirler Sirklasyona girerler Kan damarlarnn duvarlarnda toplanrlar Dokulara geerler

Granulositler

Ntrofiller

Proliferasyon

Blnen myeloblast, promyelosit, erken myelosit Blnmeyen myeloblast, metamyelosit, band (olgunlamam) hcreler Olgun ntrofiller

Olgunlama

Depolama

retimi 5 gn de olur Depoda 5 gn yetecek kadar ntrofil bulunur

Granulositler

Ntrofiller

Neutrophilia with left shift regeneratif inflamasyon

Neutropenia with left shift degeneratif inflamasyon

Granulositler

Eozinofiller

Granl

Hidrolik enzim, peroksidaz, bazik protein Histamin, Mast hcrelerinin salglad anaflaksinin eozinofil kemotaktik faktr Aktif lenfositlerin baz rnleri

ekiciler

Bakteri remesini in vitro durdurucu

Granulositler

Eozinofiller

Hipersensitiviti

Antihistamin ve prostoglandin retimi

Mast hcrelerin degranlasyonunu inhibe ederler

Parazit enfeksiyon kontrol mrleri dakika ve saatlerle snrl

Granulositler

Bazofiller

Arasra sistemik kan dolamnda grlrler Fagozitoz yapmazlar Granller

Histamin Vaskler permaabilitiyi artrrlar Heparin antikoagulant

Monosit / Makrofaj

Nonspesifik ve spesifik immun sistemler arasndaki balant Monositler makrofajlarn n yapcs

Kemik ilii kan dolam Deiime urayacaklar doku

Aktif makrofajlar Epileloid hcreler ok ekirdekli yang giant (byk) hcreleri

Monosit / Makrofaj

Makrofajlar

Fagositozun yannda

Antijen ileyen hcre Yang mediatrleri yang ortamnda aadakileri artrrlar

Ntrofil, Dier monosit, lenfosit leri

Demir depolanmasn ayarlar

Monositler retim sonunda kan dolamna verilirler, granulositler kemik iliinde depolanrlar

mmunositik sistem

Lenfositler

Sirklasyon Primer lenfoid organ (Kemik ilii & Timus) Sekonder lenfoid organ (lenf nodlleri, dalak, Peyers plaklar) Lenfokinaz mmunglobulin ( IgG, IgM, IgA, IgE)

T lenfositler

B lenfositler

mmunositik sistem

Lenfositler

1000/L - 5000/L in dogs 1000/L - 7000/L in cats Marginal Lenfopenia 1000/L - 1500/L 700/L - 1500/L lenfopenia (stress) Fizyolojik lenfositozis

Anormal Lkosit Morfoloji

Ntrofil

Dhle yaplar RNA nn stoplazma iine kmesi

Eritrositler

Oksijeni akcier alveollerinin yzeyinden almak Hcrelere gtrerek birakmak Oksijen brakrken artk gaz ve carbondioksidi almak Carbon dioksiti akcierlere getirmek

Eristrositler

Hemoglobin

Soluble tayc protein kpekte 100, kedide 80 gn

Eritrositlerin mr

Gn de 1% i lr Olgunlamam eritrositler

Polikromatofils 1% kpek , 2% kedi

Eristrositler

Polisitemia

Krmz hcre yaps (ktlesi) art Relatif

dehidrasyon Primer Sekonder Polisitemia vera myeloproliferasyon eritropoetin retiminin artmas

Absolute

Eristrositler

Anemia

Regeneratif

Hemoraji Hemolizis

IMHA Heinz Body HA Infeksiyz HA Hemobartonella Babesia Hereditary HA

Eristrositler

Anemia

Non regeneratif

Hipoproliferatif
nflamatory Eritropoetin azalmas lik toksitisi

Platelets (Trombositler)

nflamasyon Neovasklarizasyon Trombosiz Hemostazis Fibrinolizis Koaglasyon

Trombositler

retimi

Kemik ilii Kpek 5 7 gn Kedi 1 - 1.5 gn Monosit / Makrofajlar

mr

Etkisini yitiren veya l trombositler

Dalak ve karacier makrofajlar

Trombositler

Pht oluumu Fibrin deposu Pth ekimi

Trombositopeni

Trombosit

kullanmnn artmas

Kan kayb DIC mmune-mediated Endotoxemia, hepatomegaly, hypotermia, splenomegaly ntramarrow bone diseases

paralanmasnn artmas

ayrlmasnn artmas

retiminin azalmas

Leukogram

nflamasyon? Glukokortikoid (stres) cevab? Epinefrin cevab? Hipersensitiviti reaksiyon? Doku nekrozu? nflamasyon varsa daha baka snflandrma? Sistemik toksisemi?

Normal Leukogram Values

TP HCT Hb RBC WBC Bands Neutrophils Lymphocytes Monocytes Eosinophils MCV MCHC Fibrinogen Platelets PT PTT units g/dl % g/dl x106/l x103/l /l /l /l /l /l fl mg/dl mg/dl x105/l seconds seconds Dog 6.0-8.0 37-55 12-18 5.5-8.5 6-17 0-300 3000-12000 1000-5000 150-1350 100-1250 60-75 32-36 200-400 2-9 5.5-7.9 11.4-16.4 Cat 6.0-8.0 30-45 8-15 5.0-10.0 6-18 0-300 3000-12000 1500-7000 50-850 100-1500 40-55 30-36 150-300 3-7 6.4-9.6 9.3-18.7

Inflammation

Neutrophilic left shifts

Total neutrophils or WBC

Normal WBC

>300 bands/l
At least 1000 bands/l <300 bands/l

WBC 25000/l - 30000/l

WBC < normal

Eosinophilia Monocytosis

Glukokortikoid (stres) cevab

Neutrophilia Lymphopenia eosinopenia

Epinefrin cevab (excitement)

WBC

Ratio : freely circulating / marginating = 1/1

Heyacan epinefrin damar duvarlarndaki WBC dolama

Bundan dolay WBC says iki katna kar Neutrophilia in dogs Lymphocytosis in cats

Excitement leucocytosis

Hipersensitivity & Tissue Necrosis

Persistent eosinophilia

nflammation & systemic hypersensitivity

Monocytosis

Doku nekrozu

nflamasyon varsa daha baka snflandrma?

Acute inflammation

Hzl bir ekilde ntrofillerin, kemik iliinden inflamasyonun olduu blgeye gelmesi Kana lkosit aktarm (kemik iliindeki lkosit deposundan), kandan dokulara lkosit aktarmdan daha hzl olmaktadr. Bundan dolay lkosit says artar. Ayn zamanda yksek miktardaki lkosit ihtiyacndan dolay, kemik iliinden olgunlamam lkositlerde kan dolamna ekilir.

Neutrophilia with left shift (regenerative left shift) akut inflamasyon cevabdr.

Akut nflamasyon

Akut inflamasyon

Stres lenfopenia

Bazen akut inflamasyonda dokularn lkosit ihtiyac kemik iliinin retiminden daha fazladr

Total WBC & ntrofil says normalden azdr

Degenerative left shift

Kronik nflamasyon

Akut inflamasyon iyilemez devam ederse

Dereceli olarak Kronik inflamasyona geer Ntrofillerin mr ksadr ama zamanla kemikiliinden retimle dokularn kulland ntrofil oran dengelenir

Bylelikle sabit durum ortaya kar Net etki olarak ntrofillerin says normale dnerek left shift ortadan kalkar

Kronik nflamasyon

Kronik inflamasyon da stres devam eder

Lenfopenia Ayn zamanda antijenik stimulasyon sonucu Lenfositosis

Net etki normal veya hafif artm lenfosit says Doku nekrozu ve devam eden fagositoz ihtiyac nedeniyle

Kronik inflamasyonda monositosis anormal bulgudur

nflamasyon & Eritrositler

Anemi

Non-regeneratif Hematokrit

30% - 40% kpek 25% kedi

nflamasyon

Kronik inflamasyon

mmunoglobulin retimi artar

hemogram da Hyperprotenemia

Serum chemistry profilinde Hypergammaglobulinemia

nflamatory lkogram

Trombositopeni

DIC (Dissemiated Intravascular Coagulapathy)

Sistemik Toksikosyan

Enfeksiyz veya enfeksiyz olmayan kaynakl toksinler dolamda

Kemik iliinde ntrofil n yapclarn etkileyerek deimelerine neden olurlar

Eritrogram Yorumu

Total eritrosit says Hemoglobin Hematokrit Eritrosit hcre oran

MCV (mean cell volume) MCHC (mean cell hemoglobin volume)

Total protein Eritrosit morfoloji

Eritrogram Yorumu

Krmz hcre ktle

Art

Polisitemia

Relatif Absolute

Primmer Sekonder

Azal

Anemia

Regeneratif
Kan kayb Hemoliz

Non-Regeneratif

Kemik ilii

Red Cell Mass

RBC Mass indikatrleri

RBC says Hb HCT Dehidrasyona bal POLSTEMA; relatif

HCT & Total protein

Kan biyokimyasnda BUN (Blood Urea Nitrogen) drar spesifik gravitisi (Prerenal azotemia)

Dehidrasyon yoksa POLSTEMA absolute

Absolute Polisitemia

Primer veya sekonder ?

nce sekonder olmad

Primer Bbrek, Kardiovaskler veya Pulmoner hast. Cushings hast. Bbrek neoplastik hast. Polisitemia vera

Primer

Red Blood Cell Mass

Anemia

Regeneratif

Anisositozis

Farkl byklkte eritrositler

Retiklosit says > 80000/l HCT der MCV increased MCHC decreased (macrocytic hypochromic)

Marked regeneratif Anemia

Regeneratif Anemia

Kan kayb

Travma, kanama, kusma, diyare, parazit Hemoglobinuria, hemoglobinemia, retiklositosis > 200000/l

Hemoliz

Anemia

Acute

Hzl hipoksi Damage to cell membranes n parenchymal organs (liver) release of cytoplasmic enzymes (AST-ALT-LDH) Hemoliz

Bilirubin art Hemoglobinemia - hemoglobinura

Intravasculer hemolysis

Non-regenerative Anemia

HCT azalr ama retiklosit art olmaz nflamatory hastalk

Anemi (hafif veya orta) nflamatory leucogram

Non-regenerative anemi

Ciddi bbrek yetmezlii

Eritropoetin yetmezlii

Hipokromazia- mikrositosis

Demir yetmezlii

Thrombogram Yorumu

Trombosit says ve morfolojisi

Trombositosis

Reaktif veya sekonder

Dalak kontraksiyonu eksersiz Glukokortikoidler Splenectomy Fractures Kemik ilii hast. Myeloproliferatif Platelet leukemia & polisitemia vera

Primer

Trombositopenia

DIC

PTT Fibrinojen level

Questin of the Day

Signalment

3 yr-old Female DSH cat Presented for elective surgery

History 38% 12.5 g/dl 7.2x106/l 6.2 g/dl Adequate WBC Neutrophils Lymphocytes Eosinophils Monocytes 18,600/l 8,000/l 10,000/l 300/l 300/l

HCT Hb RBC TP Platelets

Normal Leukogram Values

TP HCT Hb RBC WBC Bands Neutrophils Lymphocytes Monocytes Eosinophils MCV MCHC Fibrinogen Platelets PT PTT units g/dl % g/dl x106/l x103/l /l /l /l /l /l fl mg/dl mg/dl x105/l seconds seconds Dog 6.0-8.0 37-55 12-18 5.5-8.5 6-17 0-300 3000-12000 1000-5000 150-1350 100-1250 60-75 32-36 200-400 2-9 5.5-7.9 11.4-16.4 Cat 6.0-8.0 30-45 8-15 5.0-10.0 6-18 0-300 3000-12000 1500-7000 50-850 100-1500 40-55 30-36 150-300 3-7 6.4-9.6 9.3-18.7

Questin of the Day

Signalment

1 yr-old Female Wirehair Terrier Presented for ovariohysterectomy

History 45% 15,0 g/dl 6,1x106/l 6,5 g/dl Adequate WBC Neutrophils Lymphocytes Eosinophils Monocytes 20,300/l 18,000/l 1,500/l 500/l 300/l

HCT Hb RBC TP Platelets

Questin of the Day

Signalment

8 yr-old Female Boston Terrier Polyuria & polydipsia of several weeks duration

History WBC Neutrophils Lymphocytes Monocytes Platelets 14,500/l 13,000/l 750/l 850/l Adequate

HCT 55% Hb 18,0 g/dl RBC 8x106/l TP 6,5 g/dl Nucleated RBC 5/100WBC

15.3.2007 Questin of the Day

Signalment

6 yr-old intact Female Poodle Recent onset emesis, anorexia, polydipsia, polyuria

History 30% 10.0 g/dl 4.7x106/l 6.5 g/dl Adequate WBC Neutrophils Lymphocytes Monocytes Bands 24,900/l 18,000/l 900/l 3,000/l 3,000/l

HCT Hb RBC TP Platelets

15.3.2007 Questin of the Day

Signalment

4 yr-old intact Female Irish Setter Weight Loss and distended abdomen

History 25% 8.0 g/dl 4.0x106/l 8.2 g/dl Adequate WBC Neutrophils Lymphocytes Monocytes 17,500/l 10,000/l 3,000/l 4,500/l

HCT Hb RBC TP Platelets

Normal Leukogram Values

TP HCT Hb RBC WBC Bands Neutrophils Lymphocytes Monocytes Eosinophils MCV MCHC Fibrinogen Platelets PT PTT units g/dl % g/dl x106/l x103/l /l /l /l /l /l fl mg/dl mg/dl x105/l seconds seconds Dog 6.0-8.0 37-55 12-18 5.5-8.5 6-17 0-300 3000-12000 1000-5000 150-1350 100-1250 60-75 32-36 200-400 2-9 5.5-7.9 11.4-16.4 Cat 6.0-8.0 30-45 8-15 5.0-10.0 6-18 0-300 3000-12000 1500-7000 50-850 100-1500 40-55 30-36 150-300 3-7 6.4-9.6 9.3-18.7

15.3.2007 Questin of the Day

Signalment

5 yr-old Female Mixed Breed Dog Presented in state of near collapse and extreme depression

History

HCT Hb RBC TP Platelets

50% 16.1.0 g/dl 7.2x106/l 8.5 g/dl Reduced

WBC Neutrophils Lymphocytes Monocytes Bands

5,500/l 2,000/l 900/l 1,500/l 1100/l

FLUIDS OF BODY CAVITIES

Remember that accumulation of fluid in body cavities is not a disease in itself but is an indication of a pathologic process involved in production and/or removal of fluid from the body cavity. Parameters evaluated include:

Physical findings such as transparency, color, protein concentration and specific gravity Cellular findings including enumeration of cells and evaluation of their morphology

FLUIDS OF BODY CAVITIES

Normally there is a very small amount of effusion in abdominal and thoracic cavities. An estimate of protein content and specific gravity can be determined using a refractometer. Fluid will be clear and colorless . Protein values will be less than 1 g/dl and specific gravity less than 1.015.

FLUIDS OF BODY CAVITIES

Accumulation of fluid in the abdominal or thoracic cavities is evidence of disease. This fluid should always be examined seeking a clue for the pathogenesis of the disease present. Fluids are frequently categorized as

Transudates, Modified Transudates or Exudates protein content, specific gravity, nucleated cell numbers and cell types.

based on

It is sometimes difficult to place fluids in one of these categories. Thorough history and physical examination as well as fluid analysis is necessary to make a diagnosis.

FLUIDS OF BODY CAVITIES

Cells can be enumerated using the same Unopette as is used to make a white blood cell count or an automated cell counter can be used. An estimation of cell count may be made on examination of a stained film on a slide. A slide should be made the same way a blood film is made. If the fluid is clear and appears cell poor, it should be centrifuged and the button used to make the film. If the fluid appears cellular, a slide can be made directly. Once dried, the slides can be stained with any routine quick stain

FLUIDS OF BODY CAVITIES

Transudates <2.5 gr/dl <1500ul Modified Transudates 2.5-9 gr/dl 1000-7000ul Exudates <3 gr/dl >10000ul

TRANSUDATES

Cell Types in Transudates

Mesothelial cells Macrophages An occasional neutrophil, or lymphocyte A few erythrocytes

TRANSUDATES

Hepatic Insufficiency Protein Losing Kidney Disease Protein Losing Enteropathy

CASE-TRANSUDATE

A 5 year old Doberman with a history of progressive weight loss and depression. The urinalysis had no abnormalities. The results of the chemistry profile and abdominal fluid analysis is shown next

Serum Chemistry

TP 4.8 g/dl (5.3 - 7.6) Albumin 1.5 g/dl (3.2 - 4.7) ALT 600 IU/L (10 - 94) ALP 421 IU/L (0 - 90) Prepran bile 40 umol/dl (0-15.3 micmol/L) Postpran bile 87 umol/dl (0-20.3 micmol/L)

Abdominal Fluid

Color Transparency SG Cell Count Cell type

colorless clear 1.006 397/ul a few segs and lymph

Discussion of Results

The low serum albumin suggest

the possibilities of

chronic liver disease, protein losing kidney disease, intestinal disease with malabsorption/maldigestion, hemorrhage or possibly congestive heart failure.

A urinalysis rules out proteinuria and thus protein losing kidney disease. The next easiest test would be a test of hepatic functional mass. In this case the fasting and postprandial bile acids confirm the presence of reduced functional mass as might be observed with chronic liver disease or portal caval anomaly.

CASE-2

A 3 1/2 year old Dalmatian that was presented because of a poor appetite and edema in the hind legs. The dog has polyuria and polydypsia.

Dalmatian - Serum Chemistry Results

TP 3.7 g/dl Albumin 0.9 g/dl BUN 45 mg/dl ALT 45 IU/L ALP 62 IU/L Creatinine 2.1 mg/dl

(0.5 1.4 mg/dl)

Dalmatian - Abdominal Fluid Analysis

Color Transparency SG Protein Cell Count Cell type

colorless clear 1.004 1.3 g/dl 300/ul monocytes and a few mesothelial

Dalmatian - Urinalysis

Color Transparency SG Protein Sediment

clear clear 1.035 ++++ rare RBC

Dalmatian- Other Chemistries

Urine protein / creatinine Fasting bile acid Post prandial bile acid

6.7 / 1 (<1) 2.3 ul/dl 6.5ul/dl

Dalmatian - Discussion

The low serum protein along with the ++++ proteinuria and transudate suggest protein losing kidney disease. The urine protein creatinine ratio suggests heavy protein loss(<1 is normal). Fasting and post prandial bile acid studies rule out chronic liver disease. Biopsy Diagnosis: Glomerulonephritis

Dalmatian - Discussion
Abdomimal Sv Transudat SG & Hcre 1- Karacier Yetmezlii 2- Bbreklerden protein kaybna neden olan bozukluklar 3- Barsaklardan protein kaybna neden olan bozukluklar

Kan Biyokimyas

BUN Azotemi Cr Filtrasyon TP Protein Kayb

Karacier enzim. N

drar Analizi

Ar protein kayb A