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Anaemia
British Small Animal Veterinary Association , 176 (2013); https://doi.org/10.22233/9781910443149.5.4
/content/chapter/10.22233/9781910443149.chap5_4
Anaemia
- Author: Séverine Tasker
- From: BSAVA Manual of Feline Practice
- Item: Chapter 5.4, pp 176 - 186
- DOI: 10.22233/9781910443149.5.4
- Copyright: © 2013 British Small Animal Veterinary Association
- Publication Date: January 2013
Abstract
Anaemia is commonly seen in feline practice. Cats often tolerate anaemia remarkably well, especially when it is chronic, so clinical signs may not be apparent until anaemia is very severe. This chapter looks at clinical presentation, classification of anaemia, diagnostic approach and selected causes of feline anaemia. Quick reference guides: Making and examining a blood smear; Haematological assessment; Obtaining bone marrow samples.
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5.4.1
(a) Regenerative anaemia. The RBCs show polychromasia (black arrows), anisocytosis (variation in cell size, including macrocytes) and a nucleated form (red arrow). Polychromatic cells are likely to be aggregate reticulocytes (immature RBCs) but NMB staining is required to confirm this. (b) Non-regenerative anaemia: the RBCs are uniformly normocytic and normochromic. (Diff-Quik; original magnification X500) © 2013 British Small Animal Veterinary Association
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5.4.1
(a) Regenerative anaemia. The RBCs show polychromasia (black arrows), anisocytosis (variation in cell size, including macrocytes) and a nucleated form (red arrow). Polychromatic cells are likely to be aggregate reticulocytes (immature RBCs) but NMB staining is required to confirm this. (b) Non-regenerative anaemia: the RBCs are uniformly normocytic and normochromic. (Diff-Quik; original magnification X500)
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5.4.2
Aggregate reticulocytes are identified (arrowed) by staining with new methylene blue (NMB). This cat was showing substantial regeneration. (Original magnification X500) © 2013 British Small Animal Veterinary Association
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5.4.2
Aggregate reticulocytes are identified (arrowed) by staining with new methylene blue (NMB). This cat was showing substantial regeneration. (Original magnification X500)
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5.4.3
Normal feline platelets (arrowed) are almost as large as the RBCs. (Diff-Quik; original magnification X1000, with oil immersion) © 2013 British Small Animal Veterinary Association
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5.4.3
Normal feline platelets (arrowed) are almost as large as the RBCs. (Diff-Quik; original magnification X1000, with oil immersion)
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5.4.4
A section of the feathered edge of a blood smear, showing many normal RBCs (red arrows), as well as platelet clumps (black arrows) which indicate that adequate platelet numbers are present. (Diff-Quik; original magnification X1000, with oil immersion) © 2013 British Small Animal Veterinary Association
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5.4.4
A section of the feathered edge of a blood smear, showing many normal RBCs (red arrows), as well as platelet clumps (black arrows) which indicate that adequate platelet numbers are present. (Diff-Quik; original magnification X1000, with oil immersion)
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5.4.5
Disordered clumping of RBCs (arrowed) under light microscopy confirms the presence of RBC agglutination in this positive SAT. (No stain; original magnification X500) © 2013 British Small Animal Veterinary Association
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5.4.5
Disordered clumping of RBCs (arrowed) under light microscopy confirms the presence of RBC agglutination in this positive SAT. (No stain; original magnification X500)
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5.4.6
A diagnostic approach to feline anaemia. APTT = activated partial thromboplastin time; BM = bone marrow; BMBT = buccal mucosal bleeding time; CKD = chronic kidney disease; DIC = disseminated intravascular coagulation; DKA = diabetic ketoacidosis; DM = diabetes mellitus; GI = gastrointestinal; IBD = inflammatory bowel disease; IMHA = immune-mediated haemolytic anaemia; MCHC = mean cell haemoglobin concentration; MCV = mean cell volume; NI = neonatal isoerythrolysis; PCV = packed cell volume; PRCA = pure red cell aplasia; PT = prothrombin time; RBCs = red blood cells; TP = total protein. © 2013 British Small Animal Veterinary Association
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5.4.6
A diagnostic approach to feline anaemia. APTT = activated partial thromboplastin time; BM = bone marrow; BMBT = buccal mucosal bleeding time; CKD = chronic kidney disease; DIC = disseminated intravascular coagulation; DKA = diabetic ketoacidosis; DM = diabetes mellitus; GI = gastrointestinal; IBD = inflammatory bowel disease; IMHA = immune-mediated haemolytic anaemia; MCHC = mean cell haemoglobin concentration; MCV = mean cell volume; NI = neonatal isoerythrolysis; PCV = packed cell volume; PRCA = pure red cell aplasia; PT = prothrombin time; RBCs = red blood cells; TP = total protein.
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Appearance of a good quality blood smear ready to be stained for microscopic examination. The feathered edge is indicated by arrows.
Appearance of a good quality blood smear ready to be stained for microscopic examination. The feathered edge is indicated by arrows. © 2013 British Small Animal Veterinary Association
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Appearance of a good quality blood smear ready to be stained for microscopic examination. The feathered edge is indicated by arrows.
Appearance of a good quality blood smear ready to be stained for microscopic examination. The feathered edge is indicated by arrows.
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Platelet clumping (P). This is a common finding in feline blood. Although they may be pale-staining, platelets often have a granular appearance which aids their identification. In this photo there is also ‘rouleaux’ formation (R) as the red cells line up in graceful chains; this is also a normal finding in the cat (see later). A single small lymphocyte (L) is also present. (Modified Wright’s stain; original magnification X1000)
Platelet clumping (P). This is a common finding in feline blood. Although they may be pale-staining, platelets often have a granular appearance which aids their identification. In this photo there is also ‘rouleaux’ formation (R) as the red cells line up in graceful chains; this is also a normal finding in the cat (see later). A single small lymphocyte (L) is also present. (Modified Wright’s stain; original magnification X1000) © 2013 British Small Animal Veterinary Association
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Platelet clumping (P). This is a common finding in feline blood. Although they may be pale-staining, platelets often have a granular appearance which aids their identification. In this photo there is also ‘rouleaux’ formation (R) as the red cells line up in graceful chains; this is also a normal finding in the cat (see later). A single small lymphocyte (L) is also present. (Modified Wright’s stain; original magnification X1000)
Platelet clumping (P). This is a common finding in feline blood. Although they may be pale-staining, platelets often have a granular appearance which aids their identification. In this photo there is also ‘rouleaux’ formation (R) as the red cells line up in graceful chains; this is also a normal finding in the cat (see later). A single small lymphocyte (L) is also present. (Modified Wright’s stain; original magnification X1000)
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Mature segmented neutrophil (N). The cytoplasm is clear to slightly pink-staining and the well segmented nucleus is densely packed with dark-staining, slightly stippled nuclear chromatin. The background red cells are all hypochromic (obvious central pallor) and some have a ‘target cell’ (T) morphology. Target cells are a non-specific finding in anaemia and lipid disorders and are most easily appreciated in cats with hypochromic red cells. (Modified Wright’s stain; original magnification X1000)
Mature segmented neutrophil (N). The cytoplasm is clear to slightly pink-staining and the well segmented nucleus is densely packed with dark-staining, slightly stippled nuclear chromatin. The background red cells are all hypochromic (obvious central pallor) and some have a ‘target cell’ (T) morphology. Target cells are a non-specific finding in anaemia and lipid disorders and are most easily appreciated in cats with hypochromic red cells. (Modified Wright’s stain; original magnification X1000) © 2013 British Small Animal Veterinary Association
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Mature segmented neutrophil (N). The cytoplasm is clear to slightly pink-staining and the well segmented nucleus is densely packed with dark-staining, slightly stippled nuclear chromatin. The background red cells are all hypochromic (obvious central pallor) and some have a ‘target cell’ (T) morphology. Target cells are a non-specific finding in anaemia and lipid disorders and are most easily appreciated in cats with hypochromic red cells. (Modified Wright’s stain; original magnification X1000)
Mature segmented neutrophil (N). The cytoplasm is clear to slightly pink-staining and the well segmented nucleus is densely packed with dark-staining, slightly stippled nuclear chromatin. The background red cells are all hypochromic (obvious central pallor) and some have a ‘target cell’ (T) morphology. Target cells are a non-specific finding in anaemia and lipid disorders and are most easily appreciated in cats with hypochromic red cells. (Modified Wright’s stain; original magnification X1000)
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Left shift and toxic change (LSTC). The neutrophil has basophilic (blue-staining) cytoplasm, which is one of the earliest signs of toxic change. The nucleus is also unsegmented and parallel-sided, indicating that a precursor (‘band’) neutrophil has been released in response to the same increased demand. Earlier precursors have thicker, less complex nuclei. A Howell–Jolly body (HJB) is present in one of the red cells; this remnant of nuclear material may be left behind when the immature red cell expels its nucleus as it reaches maturity – low numbers are unremarkable but more may be seen with regenerative anaemias. (Modified Wright’s stain; original magnification X1000)
Left shift and toxic change (LSTC). The neutrophil has basophilic (blue-staining) cytoplasm, which is one of the earliest signs of toxic change. The nucleus is also unsegmented and parallel-sided, indicating that a precursor (‘band’) neutrophil has been released in response to the same increased demand. Earlier precursors have thicker, less complex nuclei. A Howell–Jolly body (HJB) is present in one of the red cells; this remnant of nuclear material may be left behind when the immature red cell expels its nucleus as it reaches maturity – low numbers are unremarkable but more may be seen with regenerative anaemias. (Modified Wright’s stain; original magnification X1000) © 2013 British Small Animal Veterinary Association
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Left shift and toxic change (LSTC). The neutrophil has basophilic (blue-staining) cytoplasm, which is one of the earliest signs of toxic change. The nucleus is also unsegmented and parallel-sided, indicating that a precursor (‘band’) neutrophil has been released in response to the same increased demand. Earlier precursors have thicker, less complex nuclei. A Howell–Jolly body (HJB) is present in one of the red cells; this remnant of nuclear material may be left behind when the immature red cell expels its nucleus as it reaches maturity – low numbers are unremarkable but more may be seen with regenerative anaemias. (Modified Wright’s stain; original magnification X1000)
Left shift and toxic change (LSTC). The neutrophil has basophilic (blue-staining) cytoplasm, which is one of the earliest signs of toxic change. The nucleus is also unsegmented and parallel-sided, indicating that a precursor (‘band’) neutrophil has been released in response to the same increased demand. Earlier precursors have thicker, less complex nuclei. A Howell–Jolly body (HJB) is present in one of the red cells; this remnant of nuclear material may be left behind when the immature red cell expels its nucleus as it reaches maturity – low numbers are unremarkable but more may be seen with regenerative anaemias. (Modified Wright’s stain; original magnification X1000)
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This reactive lymphocyte (L) has slightly more abundant and basophilic cytoplasm than normal. Many of the red cells in the background show Heinz bodies (HB). These are pale to lightly eosinophilic bodies on the cell surface that may apparently overlie the red cell or may be seen on the lateral aspect as a rounded projection. They are the results of oxidative damage to haemoglobin; although low numbers of small examples may be seen in normal cats, high numbers and especially large Heinz bodies suggest an added oxidative insult. Note how large and granular normal feline platelets can be (arrowed). (Modified Wright’s stain; original magnification X1000)
This reactive lymphocyte (L) has slightly more abundant and basophilic cytoplasm than normal. Many of the red cells in the background show Heinz bodies (HB). These are pale to lightly eosinophilic bodies on the cell surface that may apparently overlie the red cell or may be seen on the lateral aspect as a rounded projection. They are the results of oxidative damage to haemoglobin; although low numbers of small examples may be seen in normal cats, high numbers and especially large Heinz bodies suggest an added oxidative insult. Note how large and granular normal feline platelets can be (arrowed). (Modified Wright’s stain; original magnification X1000) © 2013 British Small Animal Veterinary Association
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This reactive lymphocyte (L) has slightly more abundant and basophilic cytoplasm than normal. Many of the red cells in the background show Heinz bodies (HB). These are pale to lightly eosinophilic bodies on the cell surface that may apparently overlie the red cell or may be seen on the lateral aspect as a rounded projection. They are the results of oxidative damage to haemoglobin; although low numbers of small examples may be seen in normal cats, high numbers and especially large Heinz bodies suggest an added oxidative insult. Note how large and granular normal feline platelets can be (arrowed). (Modified Wright’s stain; original magnification X1000)
This reactive lymphocyte (L) has slightly more abundant and basophilic cytoplasm than normal. Many of the red cells in the background show Heinz bodies (HB). These are pale to lightly eosinophilic bodies on the cell surface that may apparently overlie the red cell or may be seen on the lateral aspect as a rounded projection. They are the results of oxidative damage to haemoglobin; although low numbers of small examples may be seen in normal cats, high numbers and especially large Heinz bodies suggest an added oxidative insult. Note how large and granular normal feline platelets can be (arrowed). (Modified Wright’s stain; original magnification X1000)
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This eosinophil (E) displays the polymorphic nucleus, usually seen as similar to neutrophils but with fewer lobules, and the cytoplasm packed with brightly eosinophilic pink-staining granules. (Modified Wright’s stain; original magnification X1000)
This eosinophil (E) displays the polymorphic nucleus, usually seen as similar to neutrophils but with fewer lobules, and the cytoplasm packed with brightly eosinophilic pink-staining granules. (Modified Wright’s stain; original magnification X1000) © 2013 British Small Animal Veterinary Association
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This eosinophil (E) displays the polymorphic nucleus, usually seen as similar to neutrophils but with fewer lobules, and the cytoplasm packed with brightly eosinophilic pink-staining granules. (Modified Wright’s stain; original magnification X1000)
This eosinophil (E) displays the polymorphic nucleus, usually seen as similar to neutrophils but with fewer lobules, and the cytoplasm packed with brightly eosinophilic pink-staining granules. (Modified Wright’s stain; original magnification X1000)
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In this basophil (B), the complex segmented nucleus is partially obscured by violet-staining granules. (Modified Wright’s stain; original magnification X1000)
In this basophil (B), the complex segmented nucleus is partially obscured by violet-staining granules. (Modified Wright’s stain; original magnification X1000) © 2013 British Small Animal Veterinary Association
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In this basophil (B), the complex segmented nucleus is partially obscured by violet-staining granules. (Modified Wright’s stain; original magnification X1000)
In this basophil (B), the complex segmented nucleus is partially obscured by violet-staining granules. (Modified Wright’s stain; original magnification X1000)
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This monocyte (M) has an open-appearing nuclear chromatin. The blue–grey staining cytoplasm is relatively abundant and small vacuoles can be seen. (Modified Wright’s stain; original magnification X1000)
This monocyte (M) has an open-appearing nuclear chromatin. The blue–grey staining cytoplasm is relatively abundant and small vacuoles can be seen. (Modified Wright’s stain; original magnification X1000) © 2013 British Small Animal Veterinary Association
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This monocyte (M) has an open-appearing nuclear chromatin. The blue–grey staining cytoplasm is relatively abundant and small vacuoles can be seen. (Modified Wright’s stain; original magnification X1000)
This monocyte (M) has an open-appearing nuclear chromatin. The blue–grey staining cytoplasm is relatively abundant and small vacuoles can be seen. (Modified Wright’s stain; original magnification X1000)
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Rouleaux (R): stacked red cells. Three lymphocytes (L) of unremarkable morphology are also present. (Modified Wright’s stain; original magnification X1000)
Rouleaux (R): stacked red cells. Three lymphocytes (L) of unremarkable morphology are also present. (Modified Wright’s stain; original magnification X1000) © 2013 British Small Animal Veterinary Association
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Rouleaux (R): stacked red cells. Three lymphocytes (L) of unremarkable morphology are also present. (Modified Wright’s stain; original magnification X1000)
Rouleaux (R): stacked red cells. Three lymphocytes (L) of unremarkable morphology are also present. (Modified Wright’s stain; original magnification X1000)
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Blister cell (B), acanthocyte (A), schistocyte (S). (Modified Wright’s stain; original magnification X1000)
Blister cell (B), acanthocyte (A), schistocyte (S). (Modified Wright’s stain; original magnification X1000) © 2013 British Small Animal Veterinary Association
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Blister cell (B), acanthocyte (A), schistocyte (S). (Modified Wright’s stain; original magnification X1000)
Blister cell (B), acanthocyte (A), schistocyte (S). (Modified Wright’s stain; original magnification X1000)
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Keratocyte (K), blister cell (B). (Modified Wright’s stain; original magnification X1000)
Keratocyte (K), blister cell (B). (Modified Wright’s stain; original magnification X1000) © 2013 British Small Animal Veterinary Association
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Keratocyte (K), blister cell (B). (Modified Wright’s stain; original magnification X1000)
Keratocyte (K), blister cell (B). (Modified Wright’s stain; original magnification X1000)
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Ovalocytes (O) and echinocytes (E). Basket cells (B) are nuclear remnants of disrupted leucocytes and are usually not clinically significant. (Modified Wright’s stain; original magnification X1000)
Ovalocytes (O) and echinocytes (E). Basket cells (B) are nuclear remnants of disrupted leucocytes and are usually not clinically significant. (Modified Wright’s stain; original magnification X1000) © 2013 British Small Animal Veterinary Association
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Ovalocytes (O) and echinocytes (E). Basket cells (B) are nuclear remnants of disrupted leucocytes and are usually not clinically significant. (Modified Wright’s stain; original magnification X1000)
Ovalocytes (O) and echinocytes (E). Basket cells (B) are nuclear remnants of disrupted leucocytes and are usually not clinically significant. (Modified Wright’s stain; original magnification X1000)
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Echinocytes (E), Heinz bodies (HB) and Howell– Jolly bodies (HJB). (Modified Wright’s stain; original magnification X1000)
Echinocytes (E), Heinz bodies (HB) and Howell– Jolly bodies (HJB). (Modified Wright’s stain; original magnification X1000) © 2013 British Small Animal Veterinary Association
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Echinocytes (E), Heinz bodies (HB) and Howell– Jolly bodies (HJB). (Modified Wright’s stain; original magnification X1000)
Echinocytes (E), Heinz bodies (HB) and Howell– Jolly bodies (HJB). (Modified Wright’s stain; original magnification X1000)
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Alternative view of above photograph, to show the position of needle insertion into the proximal humerus.
Alternative view of above photograph, to show the position of needle insertion into the proximal humerus. © 2013 British Small Animal Veterinary Association
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Alternative view of above photograph, to show the position of needle insertion into the proximal humerus.
Alternative view of above photograph, to show the position of needle insertion into the proximal humerus.
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This image is for illustrative purposes only and was taken after collection of a bone marrow sample in another cat. It shows the skeletal landmarks overlying the cat’s forelimb. The proximal humerus is made more accessible and laterally prominent if the elbow is pushed medially, as shown here, by an assistant during the procedure. If so, it is important that the assistant maintains the limb in the same position throughout the procedure.
This image is for illustrative purposes only and was taken after collection of a bone marrow sample in another cat. It shows the skeletal landmarks overlying the cat’s forelimb. The proximal humerus is made more accessible and laterally prominent if the elbow is pushed medially, as shown here, by an assistant during the procedure. If so, it is important that the assistant maintains the limb in the same position throughout the procedure. © 2013 British Small Animal Veterinary Association
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This image is for illustrative purposes only and was taken after collection of a bone marrow sample in another cat. It shows the skeletal landmarks overlying the cat’s forelimb. The proximal humerus is made more accessible and laterally prominent if the elbow is pushed medially, as shown here, by an assistant during the procedure. If so, it is important that the assistant maintains the limb in the same position throughout the procedure.
This image is for illustrative purposes only and was taken after collection of a bone marrow sample in another cat. It shows the skeletal landmarks overlying the cat’s forelimb. The proximal humerus is made more accessible and laterally prominent if the elbow is pushed medially, as shown here, by an assistant during the procedure. If so, it is important that the assistant maintains the limb in the same position throughout the procedure.
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© 2013 British Small Animal Veterinary Association
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© 2013 British Small Animal Veterinary Association
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© 2013 British Small Animal Veterinary Association
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The stylet is shown adjacent to the needle, to illustrate how far the needle has been inserted.
The stylet is shown adjacent to the needle, to illustrate how far the needle has been inserted. © 2013 British Small Animal Veterinary Association
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The stylet is shown adjacent to the needle, to illustrate how far the needle has been inserted.
The stylet is shown adjacent to the needle, to illustrate how far the needle has been inserted.
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© 2013 British Small Animal Veterinary Association
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© 2013 British Small Animal Veterinary Association
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Here the probe is seen coming out of the needle lumen at the handle end to push the core sample out into the formalin pot.
Here the probe is seen coming out of the needle lumen at the handle end to push the core sample out into the formalin pot. © 2013 British Small Animal Veterinary Association
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Here the probe is seen coming out of the needle lumen at the handle end to push the core sample out into the formalin pot.
Here the probe is seen coming out of the needle lumen at the handle end to push the core sample out into the formalin pot.
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© 2013 British Small Animal Veterinary Association
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