DOI: 10.1111/vcp.

12592

WHAT IS YOUR DIAGNOSIS?

What is your diagnosis? Unusual cells in feline blood

Harold W. Tvedten
University Animal Hospital, Swedish University of the Agricultural Sciences, Uppsala, Sweden

Correspondence
H.W. Tvedten, University Animal Hospital, Swedish University of the Agricultural Sciences, Uppsala, Sweden.
Email: harold.tvedten@slu.se

1 | CASE PRESENTATION

A 4-year-old Birman cat was admitted for acute vomiting with blood.
Among other tests, a complete hematology examination was per- F I G U R E 1 The 2 leukocytes in this photomicrograph are from a
formed. Partial hematology data are presented in Table 1. An unu- blood smear of this cat stained with May-Grunwald-Giemsa.
sual appearing leukocyte was observed in the blood smears Granules varied in size, shape, and color. Most were large, variably
(Figures 1 and 2). Identify the cell type and indicate its significance. blue granules with only a few small red granules. 91000 objective
The cat was presumed to have an intestinal foreign body, but the
cat improved quickly without surgery and was sent home but with-
out a firm diagnosis.

T A B L E 1 Laboratory data
Test Patient Reference values
Hematocrit 42% 29-50
WBC count 11.7 9 109/L 6.5-19
Segmented neutrophils 8.3 9 109/L 2.5-12.5
Band neutrophils 0.5 9 109/L 0-0.3
Lymphocytes 2.2 9 10 /L9
1.5-7.0
Monocytes 0.6 9 109/L 0.1-1.1
Other leukocytes 0.1 9 109/L NA
F I G U R E 2 Two different leukocytes are shown in a blood
SAA 8.4 mg/L 0-10
smear from this cat. The cell in the upper right is the cell in
WBC, total leukocyte count; NA, not applicable; SAA, serum amyloid A. question. May-Grunwald-Giemsa 91000 objective

Vet Clin Pathol. 2018;1–2. wileyonlinelibrary.com/journal/vcp © 2018 American Society for | 1

Veterinary Clinical Pathology
2 |
Cytologic Interpretation: Birman cat basophils
The unusual granulocytes were interpreted to be basophils in a
Birman cat. Neutrophils in the cat had prominently stained granules
(Figure 2) as previously described in this breed. This cat had normal
appearing eosinophils (Figure 3) and monocytes. By exclusion, this
granulocyte was determined to be a basophil with a similar staining
defect as with the neutrophils. The appearance of basophils in Bir-
man cats has not been previously described.
2 | DISCUSSION
A hereditary anomaly of neutrophil granule staining in purebred Bir-
man cats has been previously reported to be an alteration in the
content of lysosomal granules with an increased affinity for acidic
dyes.1 Affected cats have small reddish cytoplasmic granules in the
neutrophils. Neutrophil granule ultrastructure was found to be nor-
mal as determined by electron microscopy, and the granules also did
not stain for acid mucopolysaccharide.1 Bactericidal activity, phago-
cytosis, and oxidative function of affected neutrophils were not dif-
1
ferent from those of unaffected neutrophils.
This cat’s neutrophils had the prominent staining of neutrophil
granules seen in Birman cats. The granules in all the basophils
stained pale to dark blue and were not like normal feline basophils
(Figure 4A, B). A few small red granules in the basophils resembled
the lysosomal granules seen in the neutrophils (Figures 1 and 2).
Normal feline basophils have a uniform light lavender (mauve) cyto-
plasm with few to many darkly staining granules among larger gran-
ules that stain lavender (Figure 4A, B). Cells in the photomicrographs
are slightly bluer than seen under the microscope. Similar appearing
basophils and neutrophils were seen in 5 cats including this cat. Four
were reported by the owners to be Birman cats, while one was
reported to be a domestic shorthair (DSH) cat. The owner of the
adopted cat indicated that it was identified as a DSH cat by the
adopting facility, but that no other information was available about
F I G U R E 3 A photomicrograph of eosinophils in the blood smear
of this Birman cat. These cells appear normal and had uniform, rod
shaped, reddish granules as stained with May-Grunwald-Giemsa,
91000 objective
TVEDTEN
A B
F I G U R E 4 A and B, Photomicrographs of normal basophils from
2 different non-Birman cats. One basophil (A) is lysed, which better
reveals the size, shape, and color of normal basophil granules.
Granules were of different size and shape and were frequently
round, but few rod-shaped granules were also present. Basophil
granules are often a uniform light violet color. Occasionally, normal
feline basophils can contain many darkly blue staining granules as
shown in (B). May-Grunwald-Giemsa 91000 objective
the cat’s parentage, and the owner did not think that the cat looked
like a Birman cat. Therefore, this defect may occur in nonpurebred
Birman cats. Harvey described similar neutrophils with small reddish
granules in 2 cats (one or both being Siamese), for which a cause
was not determined, but the cats did not have a storage disease.2
The basophils of these cats resemble the Birman cat basophils
except that the granules were more uniformly and darkly stained.
Unusually, stained granules in leukocytes can suggest the pres-
ence of a storage disease. It has also been reported that the baso-
phils of cats with mucopolysaccharidosis type VI contain dark purple
staining granules.2 Valenciano et al described basophils of cats with
mucopolysaccharidosis type VI to have uniform dark blue-black gran-
ules.3 Mucopolysaccharidosis type VI could be confused with the
Birman cat anomaly because neutrophils in both syndromes have
prominent small red granules. A hematologist could misinterpret the
neutrophils and basophils of normal Birman cats as indicating a stor-
age disease. However, Birman cat basophil granule staining is more
variable and often light. The small reddish granules in the cytoplasm
of Birman neutrophils appear similar to the neutrophils in cats with
mucopolysaccharidosis type VII and GM2-gangliosidosis, and they
are similar to the Siamese cat neutrophils described by Harvey.2
However, similar to the Siamese cats, this staining anomaly of Bir-
man cats is not associated with a disease.1
Keywords
basophil, Birman cat, granulocyte
REFERENCES
1. Hirsch VM, Cunningham TA. Hereditary anomaly of neutrophil granu-
lation in Birman cats. Am J Vet Res. 1984;45:2170-2174.
2. Harvey JW. Evaluation of leukocyte disorders. In: JW Harvey, ed.
Veterinary Hematology, A Diagnostic Guide and Color Atlas. St. Louis,
MO: Elsevier Saunders; 2012:151-152.
3. Valenciano AC, Decker LS, Cowell RL. Interpretation of feline leuko-
cyte responses. In: Weiss DJ, Wardrop KJ, eds. Schalm’s Veterinary
Hematology, 6th ed. Ames, IA: Wiley-Blackwell; 2010:339.