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Clinical Pathology cytology testing
Clinical pathology: cytology
What are some cytologys that we can perform and places we would perform them?
FNA, Impression smears, BMA (Bone marrow), Ear, vaginal, Milk, Thoracocentesis, Abdominocentesis, Arhtrocentesis, Tracheal Wash, Prostate
Why would we perform an ear cytology?
Any Unhealthy Ear and to re-check it
What are the main things we are looking for in an ear cytology?
Bacteria, yeast, mites, inflammatory cells
What do we do to our slide that allows us to see the bacteria and yeast?
We use the dif-quick
What do you want to see on an ear cytology?
Few bacteria/ yeast
What do we do with an ear cytology slide before we stain it?
We heat fix it
What are a couple reasons we would perform a vaginal cytology?
To determine what phase of estrus or pyo suspect
What are the 3 main things to do to prep for a vaginal cytology?
Clean vaginal area, apply a lubricant, and moisten cotton swab
How do we collect our sample for a vaginal cytology?
Gently roll moistened cotton swab along the vaginal walls then gently roll on to a slide
What are the 4 stages of the estrus cycle?
Anestrus, Proestrus, Estrus, Diestrus
Anestrus: how long is it and what are the cells like on cytology
~4-5 months (canine)
~Non-cornified Squamous Epithelial, Intermediate, Parabasal, No RBC’s and few neutrophils
Proestrus: how long is it and what are the cells like on cytology
~Average 9 days
~Transition of non-cornified -> cornified, cytoplasm starts to become eosinophilic, RBC’s in canine, Neutrophils less abundant
Estrus: how long is it and what are the cells like on cytology
~Average 9 days
~All epithelial are cornified, pyknotic, No neutrophils, fewer RBC’s, towards end neutrophils increase and RBC’s decrease more
What does it mean if a cell is pyknotic?
Absent of nucleus
Diestrus: how long is it and what are the cells like on cytology
~About 2-3 months
~Looks like Anestrus
What hormone sets the uterus us for pregnancy, pyometra, or pseudo?
What stage of estrus do we normally get a pyometra and why?
Diestrus because of the Progesterone increase
Fine Needle aspirate
What are some reasons to perform a fine needle aspirate?
Any palpable or visible masses, lymph nodes, internal organs
What are some benefits of a FNA? Down falls?
~Cheap, no anesthesia, quick
~Small sample size, false negatives, often inconclusive
What are the 2 ways to perform a FNA?
Aspirate and stab
What are some possible finding of a FNA and how do you feel about them?
Fat- great news, Inflammatory cells and RBC’s- could be meaningless, Neoplastic cells- further testing needed!
What are the ups and downs of impression smears?
Cheap, easy, non-invasive, minimal restraint, minimal supplies
What would expect to see on an impression smear?
RBC’s, some WBC’s, possibly a little bacteria, normal cell types
What would be some abnormal findings on an impression smear?
Fungal , neoplasia
What are some neoplastic changes?
Size of cell/ nucleus, cell: nucleus ratio, multiple nucleoli, Nuclei/ nucleoli could be irregular, cytoplasmic inclucions +/or basophilia
What does neoplasia look like microscopically? Grossly?
~Large cell, irregular, Basophilic, multinucleated
~Invasive, irregular margins, fast growing, attached
Why would we perform a thoracocentesis?
Therapeutic and diagnostic
What do you always want to use when performing a thoracocentesis?
A 3 way stop cock
What materials will you use for a thoracocentesis and where will you perform this?
~22-18g needle, butterfly catheter, scrub, +/- ~anesthesia/sedation Between the ribs, VENTRAL to the fluid line
What will we do with the sample from the thoracocentesis?
Save some for sterile sample, some in EDTA tube, make slides and let air dry, stain some and examine immediately, save some un-stained slides to send out if needed, Check Specific Gravity
What are the big risks of thoracocentesis?
Stress to patient, puncture of important things like lung, heart, or major vessel, and anesthetic risks if used.
Thoracocentesis is the examination of what?
Abdominocentesis is the examination of what?
What is the reason we do abdominocentesis?
Diagnostic, not generally for therapeutic reason
Where do we generally perform abdominocentesis at?
Midline or ‘4 quadrants’ of the abdomen
What are the 4 types of effusions or fluids?
Transudates, Modified transudates, exudates, and Hemorrage
What could it mean if you pull transudate fluids?
Hepatic failure, protein losing disease, or hypoproteinemia
What could it mean if you pull modified transudates?
CHF, chylothorax, neoplasia-carcinoma, lymphosarcoma; color vary- may vary- milky white, brownish, red, or yellow
What could it mean if you pull Exudates?
Inflammatory- septic or non-septic
What could it mean if you pull hemorrhage?
Trauma, bleeding or ruptured tumor, postoperative, clotting disease
What would be a reason to examine joint effusion?
Any swollen joint
How do you collect fluid?
Sterile surgical scrub, +/- sedation, either syringe and needle or butterfly catheter, and EDTA tube
When you collect joint fluid, what do you make notes of?
Findings, color, volume
What are normal protein values in joint fluid?
Turbidity and Viscosity with joint fluid
~Turbidity- none in normal fluid
~Very viscous due to hyaluronic acid
Why is joint fluid very viscous?
It’s due to hyaluronic acid
A decrease in viscosity of joint fluid could indicate what?
Normal joint cellularity is what? In horses?
<1500 nucleated cell/ul
On examination what are the similarities and differences between Septic Arhtritis and Immune mediated polyarhtritis?
~Both painful swollen joints and have inflammatory cells
: septic will have bacteria; poly will not, septic treat with antibiotics; poly treat with steroids
Why would you perform a milk evaluation?
Detection of Mastitis
Where do we take a sample from when testing milk?
Take a sample from each quadrant
What 2 things do you want to do before catching a milk sample?
Clean the teat and discard the first few squirts
How much milk do you collect and for what tests?
7ml total: 2 for Californian Mastitis Test and 5 for culture or more specific bacterial test
What does the tests look for in milk?
Either nucleated cells or actual bacteria
When do you expect to see the highest cell counts in milk?
Beginning and end of lactation cycle
Normal Finding in Milk: Cell Count, Neutrophil %, and pH
~Cell count <300,000-500,000/ml
What are the 2 forms of mastitis contraction?
Contagious or environmental
Why do we test milk?
Because of human consumption
What are the specific reagents in the California Mastitis Test
Alkyl arylsulfonate and bromcresol purple as pH indicator
What tests are similar to the California Mastitis Test?
Whiteside test and Michigan Mastitis Test
CSF: what is it and why do we test it?
~Complete Neurological work-up, any undiagnosed neurological disease, seizures
What are the major risked involved with collection of CSF?
Damage to CNS, infection, risk associated with anesthesia
How do you collect CSF?
Under general anesthesia, collect from lumbo-sacral space or the atlantooccipital space, allow fluid to flow freely, collect in both an EDTA tube and a red top, and evaluate within 15 minutes
What is normal CSF: color, RBC, protein and nucleated cell counts, CK, glucose
~Clear and color-less
~<25 nucleated cells/ul
~CK- usually low, activity in nervous tissue can be high, so is used as an indicator of damage
~Glucose- 60-80% of blood glucose
What would a yellow CSF be?
Xanthochromia- generally secondary to hemolysis, elevated bilirubin content, older hemmerage
How is chronicity distinguished?
Phagocytosis of RBC’s, lack of platelet clumping, yellow rather than red
What are some reasons we would do a tracheal wash?
Chronic, severe or non-responsive respiratory condition in any species
What are the major risks with a tracheal wash?
Tracheal damage, aspiration with irritation to lung tissue
What are the 3 basic Tracheal wash techniques?
Orotracheal, Nasotracheal, and Transtracheal
With each type technique of tracheal wash, where do we perform it and what state is the animal in?
~Orotracheal- general anesthesia and place ET tube and catheter through that
~Nasotracheal- awake/ lightly sedated, pass through the nasal passage into trachea
~Transtracheal- surgical prep, actually cut through skin and trachea bypassing the pharynx
What do you do with the material collected from a tracheal wash?
Can be kept in sterile syringe, red top, or if delay is expect EDTA tube
How do we evaluate the prostate?
~Needle biopsy/ FNA
What do you normally find in the prostate?
Consistent size and shape, 0-few leukocytes, high nucleus to cytoplasm ratio
Abnormal prostate findings are rare in all species except what?
What would you expect to see with protatitis?
Many leukocytes (neutrophils and monocytes, may isolate bacteria
What is expected to be noticed with Prostate Metaplasia?
Change in cell morphology, often precursor to neoplasia, calls have low nucleus: cytoplasm ratio