Blood Smear Evaluation Research Articles

Abnormal Sysmex XT‐2000iV DIFF scattergram in a cat with a prominent mastocytemia

A 2-year-old neutered male domestic shorthair cat was presented to the emergency service of the National Veterinary School of Toulouse (France) for acute vomiting and diarrhea with lethargy, inappetence, and adypsia for the past 48hours. Complete blood counts were performed with the ProCyte DX at the emergency department and with the Sysmex XT-2000iV at the laboratory 2weeks later. The scattergrams from the two analyzers revealed similar unusual and abnormal dot plots. The Sysmex XT-2000iV DIFF scattergram also showed no clear separation between different leukocyte populations. The eosinophil cluster was in an abnormal location compared with that of the "typical" location in a normal cat. A blood smear evaluation revealed the presence of numerous mast cells. Thus, we hypothesized that the Sysmex XT-2000iV had detected the mast cell population, and this led to errors in the differential counts. To explore this hypothesis, we manually gated on the DIFF scattergram and performed a manual differential on the blood smear. With this new gating strategy, the Sysmex XT-2000iV and manual differentials were similar. Thus, in the case of systemic mastocytosis, mast cells can be located between the lymphocyte, monocyte, and eosinophil clusters on scattergrams.

Analysis of changes in the morphology of erythrocytes – microscopic evaluation of peripheral blood smears

Analysis of changes in the morphology of erythrocytes – microscopic evaluation of peripheral blood smears

In-vitro model of young and aged PU-based scaffold for cardiac aging studies

Standardized criteria guaranteeing harmonized interpretation among morphologists in the provision of morphology results represent an important tool to be adopted for risk management and patient safety. Aim of this work is to assess agreement among morphologists in the microscopic evaluation of the peripheral blood smear.17 morphologists participating in the external quality assessment (EQA) program individually evaluated the blood smear and recorded the results using a personal username and password. Agreement among operators was evaluated.The overall agreement rate in microscopic differential was 95% in 2016 and 97% in 2017 (acceptance limit 90%), with 6/120 and 4/120 incongruent results, respectively. The agreement for the diagnostic hypothesis was satisfactory with a full agreement being reached in 5 out of 16 cases.The creation of a tool to assess the agreement of readers providing morphological evaluations is a valuable step forward in ensuring patient safety and quality laboratory medicine.

Hematologic, biochemical, hormonal, and redox status alterations during reproductive activity in adult rams of two breeds.

Reproduction is a crucial, energy-consuming physiologic activity, which can temporarily disturb the homeostatic balance of the organism. Although rams are commonly placed in intense breeding programs on contemporary sheep farms, the clinicopathologic and redox status alterations have not been adequately studied during reproductive activity. The objective was to investigate the clinicopathologic and redox status changes in rams during reproductive activity. Thirty-seven (19 Chios and 18 Florina breed) adult, healthy rams were individually mated with ten estrus-synchronized ewes of the same breed. Blood samples were collected prior to mating, during mating, and postmating. CBC (Advia 120), cytologic blood smear evaluation, biochemical analyses (Flexor E, AVL 9180 Electrolyte Analyzer), and thyroxine measurements (Immulite 1000) were performed. The reactive oxygen metabolites (d-ROMs) test, the biological antioxidant potential (BAP) test, and oxidative stress index were used to assess redox status. The linear mixed effects model (statistical language R) was used for statistical analyses. Many, mostly breed-independent, clinicopathologic changes were detected during reproductive activity. Conversely, redox status alterations were found to be breed-dependent. Intense reproductive activity was related to mild, acute muscle damage in both breeds and mild oxidative stress in Florina rams, whereas Chios rams exhibited oxidative stress resistance. The observed clinicopathologic and redox status alterations were generally consistent with those reported during various forms of physical activity and exercise in animals and humans. Intense reproductive activity does not seem to be physiologically innocuous; however, it appears to be a relatively mild muscle-damaging physical activity.

Clinico-epidemiological spectrum of early onset neonatal sepsis in neonates admitted in NICU of a tertiary care institute

Background: Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. Neonatal sepsis may be classified into two groups : early onset sepsis and late onset sepsis . Early onset neonatal sepsis is generally associated with the acquisition of microorganisms from the mother and usually presents with respiratory distress and pneumonia.Methods: The study included one hundred term neonates with early onset neonatal sepsis. A septic screen including total leukocyte count, absolute neutrophil count, blood smear evaluation, blood cultures and C-reactive protein (CRP) were performed in all neonates with suspected sepsis to corroborate early onset sepsis diagnosis. Epidemiological parameters including gender of the neonate, mode of delivery, rural/urban residence were recorded in addition to clinical profile.Results: Respiratory distress was the most common presentation in the form of tachypnea, seen in 63 (63.0%) neonates. In present study, Staphylococcus aureus was the most common organism isolated followed by Staphylococcus epidermidis, Staphylococcus hominis, Acinetobacter baumannii and Klebsiella pneumonae.Conclusions: Early onset neonatal sepsis was seen more in males. Among the gram-positive Staphylococcus aureus and among gram negative Acinetobacter baumannii and Klebsiella pneumonae were most common organisms to be isolated.

CHRONIC MYELOGENEOUS LEUKEMIA TRANSFORMATION INTO ACUTE LYMPHOBLASTIC LEUKEMIA

Introduction : Chronic myelogeneous leukemia (CML) is a myeloproliferative neoplasm that can progress into various conditions. Transformation of CML into acute lymphoblastic leukemia (ALL) is a rare case. Case : A 22-year-old male with history of CML since 2014 and positive BCR-ABL p210 in 2017 came with complaint of weakness. Physical examination showed hepatosplenomegaly. CBC results Hb 7.1 g/dL, WBC 290,620/μL, platelet 434,000/μL. Blood smear evaluation (BSE) suggested CML blastic crisis dd AML-M5. Patient's condition got worse. CBC result showed WBC 96,770/μL and platelet 7,000/μL in 2 weeks later. BSE was dominated by mononuclear cells with scanty blue cytoplasm, no granules, no auer rods, loose chromatine and indistinct nucleoli, suggesting lymphoblasts with a proportion of 60%. Bone marrow aspiration (BMA) and immunophenotyping was done to confirm BSE. The BMA result was dominated by lymphoblast, consistent with ALL. The immunophenotyping result was CD10+, CD34+(0,99%), CD79a+, HLA-DR+, and CD20+. Molecular examination showed positive RUNX1 and NRAS while negative FLT3, NPM1 and del(5q). Discussion : BCR-ABL gene can be found both in CML and ALL. CML transformation into ALL had been reported to be related with deletion of a transcription gene. Diagnosis of ALL can be established by BMA and immunophenotyping. CD34+ expression of lymphoblast in ALL can be varied, but in this case was minimal. Conclusion : Patient with history of CML showed an ALL picture based on BSE, BMA and immunophenotyping suggesting CML transformation into ALL although CD34+ expression was minimal.

Comparative evaluation of malaria antigen test and peripheral blood smears in diagnosis of malaria

Comparative evaluation of malaria antigen test and peripheral blood smears in diagnosis of malaria - IJMMTD- Print ISSN No: - 2581-4753 Online ISSN No:- 2581-4761 Article DOI No:- 10.18231/2581-4761.2019.0008, IP International Journal of Medical Microbiology and Tropical Diseases-IP Int J Med Microbiol Trop Dis

Caso sugestivo de hemoplasmosis en coipo (Myocastor coypus): Relato de caso

The present study aims to report a case suggestive of Mycoplasma spp. in a nutria, in Pelotas, Rio Grande do Sul State, Brazil, treated at the Center for Wildlife Rehabilitation and Center and Screening of Wild Animals, Federal University of Pelotas (NURFS / CETAS – UFPel), an adult and male nutria, about 4.8 kg, was rescued at Praia do Laranjal, in the municipality of Pelotas, Rio Grande do Sul, Brazil. During the clinical care of the animal, it was observed that it had motor incoordination and prostration, besides difficulty in food intake. Blood samples were collected from the animal, packed in a tube containing anticoagulant ethylenediamine tetraacetic acid (EDTA), to perform blood counts. The hemogram was performed by cellular counting, using veterinary automation pocH-100iV Diff - Sysmex®; evaluation of blood smear, previously stained with Panotico Rápido®, by light microscopy; and measurement of total plasma proteins and plasma fibrinogen through refractometry. Through cell counting and measurement of total plasma proteins and plasma fibrinogen, it was possible to observe that the animal had anemia, leukocytosis and a possible hyperfibrinogenemia. Blood smear observation showed extracellular basophilic structures attached to the red blood cells, compatible with the morphological description of Mycoplasma spp., suggesting acute hemoplasmosis. In the clinical setting, antibiotic therapy with 2.5% enrofloxacin (7 mg / kg) was instituted. After 15 days of therapeutic protocol, it was possible to observe clinical improvement and erythrocyte parameters of the animal, suggesting that the success of the therapeutic protocol corroborates with the suggestive infectious disease.

Diagnostic challenges of de novo acute leukemia with positive BCR-ABL1 fusion: Case report and review of literature

A 32-year-old female was admitted because of an acute course of gum bleeding and fatigability. On complete blood cell counts, bicytopenia was evident. Morphologic evaluation of the peripheral blood smear and bone marrow materials revealed remarkable involvement by two separate blastic populations (myeloid/B-cell lymphoid). Karyotyping, fluorescence in situ hybridization, and molecular analysis showed positive Philadelphia chromosome and BCR-ABL1 (p210) fusion. chronic myeloid leukemia in blast phase (CML-BP) versus mixed phenotype acute leukemia was critically debated as to which the final diagnosis should be assigned.

Clinical features and laboratory findings in children hospitalized with acute Epstein-Barr virus infection: a crosssectional study in a tertiary care hospital.

Çağlar İ, Topal S, Çokboz M, Düzgöl M, Kara A, Bayram SN, Apa H, Devrim İ. Clinical features and laboratory findings in children hospitalized with acute Epstein-Barr virus infection: a cross-sectional study in a tertiary care hospital. Turk J Pediatr 2019; 61: 368-373. Epstein-Barr virus (EBV) is widespread all over the world. It causes infectious mononucleosis (IM) mostly in adolescents and adults. Although IM is considered to be rare in younger children and infants, acute EBV infection may have various manifestations in this age group. We aimed to describe the clinical features and laboratory findings of children hospitalized with acute EBV infection. All children hospitalized at Dr. Behçet Uz Children`s Hospital, between January 2010 and January 2017, who tested positive by presence of EBV-specific antibodies and had the diagnosis of acute EBV infection, were included (n=66). Thirty four of the patients (51.5%) were under 6 years of age, and 23 (34.8%) children were below 3 years of age. The most common physical finding was fever (92.4%) followed by cervical lymphadenopathy and tonsillopharyngitis. Leukocytosis (65.1%) and lymphocytosis (42.4%) were the most common laboratory findings. Reactive and atypical lymphocytes were present in 77.2% of the patients. Fifty-three (80.3%) of the patients had a doctor visit before hospitalization, and the ratio of patients using antibiotics was 77.3%. Skin rash was observed in 14 (27.4%) of the patients who used antibiotic treatment and in 2 (13.3%) of the patients who did not (p > 0.05). EBV infection resulting in admission to hospital is common in younger children, even in pre-school period. Serological tests for EBV specific antibody responses and peripheral blood smear evaluation are important diagnostic tools. In addition, rapid streptococcal antigen test and throat culture should be performed in patients presenting with tonsillopharyngitis in order to exclude Group A beta-hemolytic streptococci and reduce unnecessary antibiotic consumption.

Can the leukocyte`s parameters in peripheral blood smear predict risk of in-hospital death of patients undergoing high-risk gastrointestinal surgery?

White blood cell (WBC) count constitutes a part of routine peripheral blood examination (FBC, full blood count). Precise analysis of leukocytes' parameters in blood smear is usually performed only when leukopenia or leukocytosis is found. We aimed to assess the usefulness of leukocytes' smear test in predicting in-hospital death of patients undergoing high-risk gastrointestinal (GI) surgery. Materials & Methods. We prospectively enrolled 101 subjects undergoing high-risk GI surgery from 01.01.2017 till 31.12.2017. Blood tests were performed preoperatively, with analysis focused on the assessment of total WBC count, as well as the count of neutrophils (NEUT), lymphocytes (LYM), monocytes (MONO), eosinophils (EOS) and basophils (BASO). Indices of NEUT/LYM (NLR) and MONO/LYM (MLR) were calculated. In-hospital mortality was considered the outcome. Mortality reached 5%. There was no significant difference in WBC count between survivors and the deceased (p=0.2) and WBC failed to predict the outcome (AUC=0.69; p=0.3). MONO (p=0.009) and BASO (p=0.02) counts, as well as MLR (p=0.007) were significantly higher in patients who died. MONO count and MLR index predicted in-hospital death with good accuracy, respectively: AUC[MONO]=0.85 (p<0.001) and AUC[MLR]=0.86 (p<0.001). Other investigated parameters played no significant role in outcome prediction. Routine peripheral blood smear evaluation should be considered in all patients undergoing high-risk GI surgery, because the number of monocytes can be a valuable predictor of in-hospital death.

Flow Cytometric Measurement of the Initial In Vivo Response to Prednisone Provides New Prognostic Information in Childhood Acute Lymphoblastic Leukemia (ALL)

▪Background The initial in vivo response on corticosteroid therapy (<1000 blasts/mmc at day 8 after exposure to Prednisone) is considered a prognostic predictor to qualify patients at higher risk of relapse (Riehm H et al, Klin. Padiat. 199, 1986). This parameter has been prospectively validated in several BFM-oriented trials providing evidences to be a robust predictor of disease recurrence even in specific subgroups of ALL (Schrappe M et al, Klin. Padiat. 2013). Evaluation of day8 prednisone response is assessed by morphological evaluation of peripheral blood (PB) smears, however this approach may have several limitations such as poor quality of the smears, operator- dependent variability and accuracy, poor reproducibility between centers.Methods We studied a total of 543 (of 648 eligible) patients enrolled in the AIEOP-BFM ALL 2000 study between January 2001 and December 2011 in the centers of Monza and Padova (275 and 268 patients respectively). PB collected at day+8 of induction phase was analyzed by multiparametric flow cytometry (FCM) to assess blast immunophenotyping by standard methods developed in the context of the I-BFM Flow network (Dworzak MN et al, Cytometry part B, 2008).Results Five hundred-seven patients (93.4%) had <1000 blasts/mmc as assessed by FCM, whereas 36 (6.6%) had ≥1000 blasts/mmc. Five-year Event Free Survival (5 yrs EFS) was 84.8% and 76.4% respectively (p-value =0.01). We further investigated the absolute count by sub-grouping the patients in three levels: i) 0<100 blasts/mmc (n 416), ii) ≥100<1000 blasts/mmc (n 91), and iii) ≥ 1000 blasts/mmc (n 36). 5 yrs EFS was 86.8%, 75.6% and 76.4%, respectively (p-value group a vs group b was 0.001), see Figure. Five years Cumulative Incidence of Relapse (5yrs CIR) was 11.4%, 21.1% and 17.9%, respectively (p-value group a vs group b was 0.003). When we excluded the high-risk (HR) patients from the analysis, those in the group with ≥100<1000 blasts/mmc (n71) maintained a significant worse outcome as compared with the group of patients with 0<100 blasts/mmc.Conclusions We identified a group of 71 patients (13% of total) with non-HR characteristics and with ≥100<1000 blasts/mmc at day8, showing significant worse outcome as compared to patients with <100 blasts/mmc, that could benefit of a more intensive treatment. These Analyses will be validated on a larger cohort of patients. FCM is more accurate and reproducible as compared to morphology and should be considered as an alternative method for the evaluation the initial in vivo response to corticosteroid therapy and possibly for a further refinement of treatment stratification of children with ALL. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Characterization of anti-EBA175RIII-V in asymptomatic adults and children living in communities in the Greater Accra Region of Ghana with varying malaria transmission intensities

BackgroundAntibodies against Region III-V of the erythrocyte binding antigen (EBA) 175 (EBA175RIII-V) have been suggested to provide protection from malaria in a natural infection. However, the quality and quantity of naturally induced antibodies to EBA175RIII-V has not been fully characterized in different cohorts of Ghanaians. This study sought to determine the characteristics of antibodies against EBA175RIII-V in asymptomatic adults and children living in two communities of varying P. falciparum parasite prevalence in southern Ghana.MethodsMicroscopic evaluation of thick and thin blood smears was used to identify asymptomatic Plasmodium falciparum carriage and indirect enzyme linked immunosorbent (ELISA) used to assess antibody concentrations and avidity.ResultsParasite carriage estimated by microscopy in Obom was 35.6% as opposed to 3.5% in Asutsuare. Levels of IgG, IgG1, IgG2, IgG3 and IgG4 against EBA175RIII-V in the participants from Obom were significantly higher (P < 0.05, Dunn’s Multiple Comparison test) than those in Asutsuare. However the relative avidity of IgG antibodies against EBA175RIII-V was significantly higher (P < 0.0001, Mann Whitney test) in Asutsuare than in Obom.ConclusionsPeople living in communities with limited exposure to P. falciparum parasites have low quantities of high avidity antibodies against EBA175RIII-V whilst people living in communities with high exposure to the parasites have high quantities of age-dependent but low avidity antibodies against EBA175RIII-V.

Detection of Tickborne Relapsing Fever Spirochete, Austin, Texas, USA.

In March 2017, a patient became febrile within 4 days after visiting a rustic conference center in Austin, Texas, USA, where Austin Public Health suspected an outbreak of tickborne relapsing fever a month earlier. Evaluation of a patient blood smear and molecular diagnostic assays identified Borrelia turicatae as the causative agent. We could not gain access to the property to collect ticks. Thus, we focused efforts at a nearby public park, <1 mile from the suspected exposure site. We trapped Ornithodoros turicata ticks from 2 locations in the park, and laboratory evaluation resulted in cultivation of 3 B. turicatae isolates. Multilocus sequencing of 3 chromosomal loci (flaB, rrs, and gyrB) indicated that the isolates were identical to those of B. turicatae 91E135 (a tick isolate) and BTE5EL (a human isolate). We identified the endemicity of O. turicata ticks and likely emergence of B. turicatae in this city.

Live remote digital microscopy in peripheral blood smear evaluation: Intraobserver concordance and experience.

Peripheral blood smear (PBS) review is a routine laboratory test which requires pathologist's interpretation when abnormal indices, atypical cells, or critical findings are identified. Real-time remote digital microscopy (DM) can potentially facilitate rapid review when an on-site pathologist is not available. Herein, we assess intraobserver concordance of PBS evaluation with light microscopy (LM) and DM using VisionTek M6 robotic DM and TeamViewer imaging software. Thirty-seven de-identified PBS slides were evaluated by five reviewers. Slides were loaded on a VisionTek M6 robotic microscope at an off-site laboratory and evaluated remotely via TeamViewer software. Reviewers recorded interpretation, time required for interpretation (in minutes), imaging quality (score 0-3), and confidence of interpretation (score 0-3). Other relevant information associated with DM evaluation was also documented. Slides were subsequently evaluated using LM after washout interval. The intraobserver variation of results for impression, digital slide quality, minutes to interpretation, and confidence of interpretation was compared between DM and LM. The intraobserver concordance between LM and DM was 93%, with nine discordant interpretations among 135 evaluations under each review modality, respectively. Although reviewers spent more time under DM mode (5min/slide) than LM mode (2.5min/slide), the reviewers felt the DM provided sufficient image quality and the confidence levels of reviewers on slide interpretation were comparable between DM (2.6/3) and LM (2.8/3). There was a high level of intraobserver concordance and comparable interpretation confidence between DM and LM. DM can be a useful methodology for off-site pathologist's review of PBS.

TALASEMIA BETA HEMOGLOBIN E (Hemoglobin E Beta Thalassemia)

Thalassemia is a quantitative abnormality of the hemoglobin marked by inadequate hemoglobin synthesis due to the lack orabsence of synthesis of one or more globin polypeptide chains. Hemoglobin variant is a qualitative abnormality due to the presence ofthe abnormal amino acid sequence of one or more globin polypeptide chains. HbE β thalassemia is a disorder of hemoglobin that resultsfrom the fusion between the gene β-thalassemia allele from one parent with a gene HbE allele from another parent. In this case, HbEβ-Thalassemia patient was a 4.8 year girl diagnosed with hemoglobin E-beta thalassemia based on history and clinical manifestations;pale, the presence of splenomegaly and hepatomegaly. Laboratory tests were Hb: 7.7 g/dL, MCV: 52.9 fl, MCH: 17.7 pg, MCHC: 33.5g/dL and ferritin: 1012 ng/mL. Peripheral blood smear evaluation showed a microcytic hypochromic anemia with hemolytic signs andinfected features of leukocytes. Hb electrophoresis using HPLC showed a Hb F: 37.7% and HbA2 52.4%, indicating that HbA2 was falsehigh due to coeluating with HbE. The patient was treated by blood transfusion and received additional therapy such as folic acid, ironchelation and vitamin E.

Immature to Total Neutrophil (I/T) Ratio sebagai penunjang Diagnosis Sepsis Neonatorum

Early diagnosis of neonatal sepsis plays an important role in the management of patients. Blood culture, currently used as thegold standard, has several limitations such as time consuming and low positive rate. For this reason, a rapid and accurate diagnosticmethod is required. Manual differential count is a practical, inexpensive method and can support the diagnosis of bacterial infections.A shift to the left in differential white count with a raised immature neutrophil count has been documented in patients with bacterialinfections. This led to the use of I/T ratio as a indicator towards bacterial infections. The aim of this study is to obtain the diagnosticvalue of I/T ratio in diagnosing neonatal sepsis. The study was a prospective and cross-sectional. The subjects were enrolled consecutively,consisting of newborn babies (from birth to 30-days old) admitted to the Neonatal Intensive Care Unit (NICU) of the Dr. SoetomoHospital, Surabaya. Forty and three samples, consisting of 13 sepsis samples and 30 nonsepsis as controls samples were examined. I/Tratio are a ratio between immature neutrophils against total neutrophils in blood smear preparation. For the determination of the whitecell differential count, a total of 100 white cells (granulocytes) were counted. I/T ratio &gt; 0.2 showed an abnormality that suggestaninfection process occur. Blood smear evaluations were done by three (3) independent observers. The result from three (3) observerswere as follows: sensitivity and specificity of I/T ratio in the diagnosis of neonatal sepsis were 69.2%, 92.3%, 61.5% and 50%, 50%,63.3%, respectively. Positive and negative predictive values were 37.50%, 44.44%, 42.10% and 78.94%, 93.75%, 79.16%, respectively.According to Cochran test there was no difference found between the 3 observers (p = 0.086). However, using Kappa test no agreementbetween I/T ratio and sepsis (p = 0.051) differences were found. from this study so far, the value in the diagnosis of neonatal sepsis theI/T ratio showed a low diagnostic.

New insights into smudge cell percentage in chronic lymphocytic Leukemia: A novel prognostic indicator of disease burden

BackgroundPercentage of smudge cells in CLL patients has recently been reported as a novel prognostic factor. ObjectivesTo investigate the impact of smudge cells percentage on the clinicolaboratory data of CLL patients and to evaluate the relationship between it and other prognostic factors in CLL. MethodsNinety adults with CLL were enrolled. Smudge cells percentage was calculated by microscopic evaluation of blood smears. Testing of CD38 expression was done by immunophenotyping and detection of ATM, P53 deletions and trisomy 12 were performed using fluorescent in situ hybridization (FISH) ResultsLower smear cells percentage (<30%) was significantly correlated with age, lymphadenopathy, organomegaly and advanced staging. It was also associated with high TLC, low hemoglobin and platelets count and high absolute and atypical lymphocytic count. Correlation studies with other prognostic factors revealed an association between low smear cells percentage and CD38 expression, short LDT, P53 and ATM deletions. Logistic regression analysis was also done to provide complementary prognostic information identifying the significant independent factors that predict low smear cell percentage. Conclusionlow percentage of smudge cells (<30%) could be considered as an adverse prognostic predictor being associated with high risk markers in CLL.

Carcinocythemia: First report in a cat and literature review

A 6-year-old female neutered European Shorthair cat was presented with a 2-day history of lethargy and hyporexia. On physical examination, the cat was slightly depressed and had a 2.5 cm nodule in the left 3rd mammary gland. The hemogram revealed mild leukocytosis with mature neutrophilia and moderate thrombocytopenia. On blood smear evaluation, rare pleomorphic cells, possibly of epithelial origin, were observed mainly at the feathered edge. The animal died about 12 hours after presentation, and a necropsy was performed. On histopathology, the mammary nodule was diagnosed as a tubulopapillary adenocarcinoma with vascular invasion and widespread metastases. Immunocytochemical tests for cytokeratins (AE1/AE3) confirmed the epithelial phenotype of the neoplastic cells observed on the blood smear. The present report describes a feline mammary carcinoma with widespread metastases and the presence of malignant epithelial cells in the peripheral blood referred to as carcinocythemia. This condition has been previously described in people and dogs. To the author's knowledge, this is the first reported case of feline carcinocythemia. As in other species, the phenomenon was associated with a terminal phase of systemic malignancy.

Prevalence of Anaplasma phagocytophilum infection in feral cats in Massachusetts.

ObjectivesThe primary objective of this study was to determine the prevalence of Anaplasma phagocytophilum infection and exposure in adult feral cats in Massachusetts, an endemic area for A phagocytophilum and its tick vector Ixodes scapularis. The secondary objective was to determine if there were correlations between A phagocytophilum infection and the presence of anemia and thrombocytopenia.MethodsBlood samples were collected between June and December 2015 from 175 apparently healthy adult feral cats that were presented to trap and release spay/neuter centers in Massachusetts. Complete blood count, blood smear evaluation, SNAP 4Dx Plus test (IDEXX) and A phagocytophilum PCR were performed on all samples to document acute infection (PCR-positive and/or inclusions observed on blood smear) and exposure to A phagocytophilum (SNAP 4Dx Plus-positive for A phagocytophilum antibodies).ResultsThe prevalence of exposure to A phagocytophilum in feral cats in Massachusetts was 9.7%, whereas the prevalence of acute infection was 6.9%. All blood smears were negative for Anaplasma species inclusions; therefore, acute infection was defined as testing positive on PCR analysis. No statistically significant correlations were identified for cats that were positive for A phagocytophilum on PCR analysis or SNAP 4Dx Plus test and the presence of anemia or thrombocytopenia.Conclusions and relevanceThe prevalence of A phagocytophilum exposure in feral cats approaches 10% and is higher than the previously reported national average prevalence of 4.3% in the USA. A phagocytophilum infection may be an emerging infectious disease in cats. Further research is needed to determine the prevalence of clinical illness associated with A phagocytophilum infection in cats living in endemic areas.