Erythrocyte indices and volume distribution in a dog with stomatocytosis

Stomatocytosis in a Beagle and Australian Cattle Dog

BACKGROUND

Canine stomatocytosis is a well-recognized rare erythrocyte disorder characterized by nonsyndromic forms with selective erythroid involvement, syndromic forms with extra-hematologic disease, and acquired forms.

OBJECTIVES

We describe serial clinicopathologic changes in two dogs with stomatocytosis of breeds that are different from those previously reported.

METHODS

Blood samples were obtained from a 12-year-old female neutered Australian Cattle Dog and a 12-year-old male neutered Beagle for hematologic and biochemical analyses, including a morphologic examination of peripheral blood films. Serial clinicopathologic data were reviewed, including CBCs performed by the referring veterinary surgeons.

RESULTS

Serial CBC data in both cases reported a variable decrease in RBC numbers commonly associated with a normal hematocrit, macrocytosis, hypochromasia, changes in red cell distribution width parameters including marked histogram abnormalities in volume distribution of the RBC population, and mildly increased or normal reticulocyte counts. Morphologic examination of peripheral blood films identified variable numbers of stomatocytes, knizocytes (Case 1, Day 1, Day 4), mild anisocytosis, mild macrocytosis, and mild polychromasia.

CONCLUSIONS

In both cases, the changes exhibited in the erythrogram raise suspicion for an RBC membrane disorder with cell volume dysregulation and stomatocytosis, although they did not appear to cause clinically relevant hemolysis.

Histograms of Complete Blood Counts in Dogs: Maximizing Diagnostic Information

Histograms, which are an integral part of the automated complete blood count, are now available through most of the automatic hematology analyzers used in veterinary clinical practice. Data concerning the size and number of blood cells are graphically presented in histograms, and their variations are also illustrated. Important information that is not apparent from numerical results are sometimes provided by histograms. Histograms are also referred to as frequency distribution curves and are essentially graphs resulting from the placement of the sizes of cells on the x-axis and the number of cells on the y-axis. Typically, automated analyzers provide histograms for each class of blood cells, that is, for erythrocytes, leukocytes, and platelets. Thus, when the erythrocyte histogram shows asymmetry with a right shift, it means the size of the erythrocytes is greater than normal (macrocytosis); when it presents a left shift, the size of the erythrocytes is less than normal (microcytosis). When two peaks are found in the curve, two populations of erythrocytes coexist, as in the case of a blood transfusion or therapeutic response. In the leukocyte histogram, three peaks are found: the closest to the y-axis (left) corresponds to the lymphocytes, the middle to the monocytes, and the right to the polymorphonuclear cells (neutrophils, eosinophils, and basophils). Finally, in platelet histogram, asymmetry with a right shift suggests the presence of giant platelets or schistocytes. Although the histogram is not recommended as a stand-alone test, it allows the practitioner to observe abnormalities in the distribution curve that correspond to abnormalities in the size or number of cells, and to quickly make diagnostic or therapeutic decisions that are particularly important in emergencies.

Red blood cell distribution width in dogs with chronic degenerative valvular disease

OBJECTIVE

To evaluate RBC distribution width (RDW) in dogs with chronic degenerative valvular disease (CDVD) with compensated or decompensated heart failure.

DESIGN

Retrospective case-control study.

ANIMALS

27 healthy dogs and 135 dogs with CDVD (87 dogs with compensated heart failure and 48 dogs with decompensated heart failure).

PROCEDURES

The RDW and various CBC and serum biochemical variables were compared among groups. Correlations between RDW and various echocardiographic variables were evaluated.

RESULTS

Mean ± SD RDW in dogs with CDVD (13.1% ± 1.0%) was not significantly different from that of healthy dogs (12.8% ± 0.8%). The RDW of dogs with CDVD and compensated heart failure (13.0% ± 1.0%) was not significantly different from that of dogs with CDVD and decompensated heart failure (13.2% ± 1.1%). The RDW had a significant, weak, negative correlation with Hct (correlation coefficient, -0.250), hemoglobin concentration (correlation coefficient, -0.219), and mean corpuscular volume (correlation coefficient, -0.211). The RDW had a significant, weak, positive correlation with 1 echocardiographic index of CDVD severity (ie, the left atrium-to-aorta ratio [correlation coefficient, 0.183]).

CONCLUSIONS AND CLINICAL RELEVANCE

In this study population, RDW did not seem to be associated with the presence of heart failure or CDVD.

Cation-leak stomatocytosis in standard schnauzers does not cosegregate with coding mutations in the RhAG, SLC4A1, or GLUT1 genes associated with human disease

Autosomal dominant overhydrated cation-leak stomatocytosis in humans has been associated with missense mutations in the erythroid membrane transport genes AE1, RhAG, and GLUT1. Syndromic stomatocytosis has been reported in three dog breeds, but stomatocytosis in Standard Schnauzers is usually asymptomatic, and is accompanied by minimal if any anemia. We have extended the evaluation of a cohort of schnauzers. We found that low-level stomatocytosis was accompanied by increased MCV and increased red cell Na content, and minimal or no reticulocytosis. Red cells from two affected dogs exhibited increased currents in on-cell patches measured in symmetrical NaCl solutions, but Na,K-ATPase and NKCC-mediated cation flux was minimal. Three novel coding polymorphisms found in canine RhAG cDNA and three novel polymorphisms found in canine SLC4A1 cDNA did not cosegregate with MCV or Na content. The GLUT1 cDNA sequence was normal. We conclude that unlike human overhydrated cation-leak stomatocytosis, stomatocytosis in this cohort of Standard Schnauzers is not caused by mutations in the genes encoding RhAG, SLC4A1, or GLUT1.

Diagnostic accuracy of using erythrocyte indices and polychromasia to identify regenerative anemia in dogs

OBJECTIVE

To determine diagnostic accuracy of using erythrocyte indices and polychromasia to identify regenerative anemia in dogs.

DESIGN

Retrospective and prospective cross-sectional study.

ANIMALS

4,521 anemic dogs.

PROCEDURES

CBC results obtained between July 2002 and July 2008 by use of an automated laser-based flow cytometric hematology analyzer from dogs with Hct values ≤ 35% were retrieved. Sensitivity, specificity, accuracy, and predictive values of using erythrocyte indices and polychromasia to identify regeneration were determined, with a reticulocyte count > 65,000 reticulocytes/μL considered the gold standard. Similarly, 134 blood samples from anemic dogs were analyzed prospectively with an in-house electrical impedance analyzer.

RESULTS

Of 4,387 dogs with samples analyzed retrospectively, 1,426 (32.5%) had regenerative anemia. Of these, 168 (11.8%) had macrocytic hypochromic anemia. High mean cell volume and low mean cell hemoglobin concentration had low sensitivity (11%), high specificity (98%), and moderate accuracy (70%) when used to identify regenerative anemia. Use of polychromasia alone had an accuracy of 77%, and use of polychromasia combined with a high RBC distribution width (RDW) had an accuracy of 79%. Results obtained with the in-house analyzer were similar.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that most regenerative anemias in dogs were not macrocytic hypochromic. Polychromasia, with or without high RDW, was a more accurate indicator than other erythrocyte indices of regenerative anemia. To avoid a false diagnosis of nonregenerative anemia, a blood smear should be evaluated in anemic dogs when a reticulocyte count is not available.

Stomatocytosis of Standard Schnauzers is not associated with stomatin deficiency

Stomatocytosis resembles human overhydrated hereditary stomatocytosis (OHSt), a disease characterised by a reduced or absent stomatin expression. The objective of this report was to investigate the expression level of stomatin in erythrocytes from Standard Schnauzers with stomatocytosis. Routine haematology, intraerythrocytic Na(+)/K(+) concentration and stomatin expression were evaluated in blood from twelve Standard Schnauzers and from three controls. SDS-PAGE and Western blotting on isolated integral membrane proteins were used to investigate stomatin expression. Circulating stomatocytes, macrocytosis, anisocytosis, increased erythrocyte fragility and high intracellular sodium and potassium concentrations were found in 10/12 dogs from the same breeding line although stomatin levels were similar to those of controls. In spite of the clinico-pathological similarities between human and canine stomatocytosis, erythrocytes from affected dogs do not lack stomatin and the expression level of this protein cannot therefore be used to diagnose hereditary stomatocytosis in Standard Schnauzers.

Stomatocytosis in 7 related Standard Schnauzers

BACKGROUND

Hereditary canine stomatocytosis has been described in purebred Alaskan Malamutes, Drentse Patrijshonds, and Miniature Schnauzers. In humans, hereditary stomatocytosis is a heterogeneous group of congenital disorders characterized by the presence of stomatocytes in blood, increased osmotic fragility, and frequently, hemolytic anemia.

OBJECTIVE

Our objective was to describe hematologic findings and RBC characteristics in 7 closely related Standard Schnauzers with stomatocytosis.

METHODS

The following parameters were measured using an automated analyzer: HCT, RBC, hemoglobin (Hb) concentration, MCV, MCH, MCHC, red cell distribution width (RDW), WBC, platelet count, mean platelet volume (MPV), thrombocrit (PCT), and platelet distribution width (PDW). Differential leukocyte count, platelet estimate, reticulocyte count, and the percentage of stomatocytes in blood films were microscopically evaluated. An osmotic fragility test of RBCs and measurement of intracellular Na+, K+, and 2,3-diphosphoglycerate (2,3-DPG) concentrations were also performed.

RESULTS

The affected dogs had macrocytosis (80.0 +/- 4.2 fL, reference interval 60-76 fL), decreased MCHC (29.3 +/- 0.8 g/dL, reference interval 32-39 g/dL), slightly increased RDW (17.3 +/- 0.4%, reference interval 12-16%), and an increased reticulocyte count (1.55 +/- 0.77%, reference interval <1%). The percentage of stomatocytes in blood films varied from 0.6 to 18.9% of all RBCs. Erythrocyte osmotic fragility and intracellular Na+ (138.1 +/- 3.2 mmol/L; controls 99 +/- 6.1 mmol/L), K+ (8.1 +/- 0.8 mmol/L; controls 6.1 +/- 0.5 mmol/L), and 2,3-DPG (21.9 +/- 2.0 micromol/g Hb; controls: 14.6 +/- 3.3 micromol/g Hb) concentrations were increased in dogs with stomatocytosis.

CONCLUSIONS

Hematologic findings and the metabolic defects in RBCs in these Standard Schnauzers were consistent with a diagnosis of stomatocytosis. Parentage analysis suggests that stomatocytosis in Standard Schnauzers may have a hereditary component.

The hereditary stomatocytoses and allied disorders: congenital disorders of erythrocyte membrane permeability to Na and K

The hereditary stomatocytoses and allied disorders are a set of dominantly inherited haemolytic anaemias in which the plasma membrane of the red cell 'leaks' sodium and potassium. There are about 10 different forms of these conditions, ranging from a moderately severe haemolytic anaemia to minor conditions in which the haematology is essentially normal, but where the patients present with pseudohyperkalaemia, due to leakage of K from the red cells on cooling to room temperature. Frequently misdiagnosed as atypical hereditary spherocytosis, these conditions can show marked thrombotic complications after splenectomy, which should be avoided. Laboratory studies of these conditions have drawn attention to a 32 kDa membrane protein, stomatin, which seems to act as a regulator of Na and K transport in human and animal tissues generally, but mutations in this gene do not cause these diseases. Genetic mapping in some kindreds, but not all, points to a mutation locus on chromosome 16.