34. non regenerative anemias

Question 1

what to mention

Answer 1

definition 
causes of non regenerative anemia 
toxic injuries of BM 
infectious diseases 
non regenerative IMHA
deficiencies 
anemia of chronic disease 
diseases causing non regenerative anemia 
treatment of non regenerative anemias

Question 2

non regenerative anemia definition

Answer 2

lack of regenerative response from BM
reticulocyte count is low
reticulocyte index below 2,5

Question 3

causes of non regenerative anemia

Answer 3

something is missing: iron, B9, B12, EPO 
something is destroying BM:
idiopathic
infectious: felt, erlichia 
drug, toxin
immune mediated 
myelofibrosis, myelodysplasia

Question 4

toxic injuries of BM

Answer 4

1. chemotherapy
2. estrogen
3. anti-inflammatory drugs (PBZ, azathriopin)
4. antibiotics (potSA)
5. anticonvulsive (Phenobarb)
   6: antiparasitic (fenbendazole)

Question 5

infectious diseases causing BM damage

Answer 5

virus: parvo, FeLV - BM dysplasia
rickettsia: ehrlichiosis
leishmaniosis
fungal: histoplasmosis
diagnosis: screening, Ab, Atg, PCR

Question 6

non regenerative immune mediated hemolytic anemia

Answer 6

parachute hemolysis -> intravascular
if more than five days non regenerative - destroy erythroid precursor
BM: dysymyelopoiesis, necrosis
treat: like IMHA, pred, cyclosporine

Question 7

deficiency anemias

Answer 7

iron deficiency: chronic blood loss (parasites, GI bleed, cystitis)
B12 def: chronic gi diease, EPI
lack of EPO: chronic kidney disease

Question 8

anemia of chronic disease

Answer 8

lack of hormones: mild normocytic, normochromic, non regenerative. hypothyreosis, Addison !! dehydration will mask it

portosystemic shunt: can cause non regenerative anemia

increased hepcidin production: iron sequestration. inflammatory diseases: IBD, pyometra, sepsis

Question 9

diseases causing non regenerative anemia

Answer 9

myelodysplastic syndromes
acute lymphoblastic leukemia
chronic lymphocytic leukemia

Question 10

mkalodystrophic syndromes

Answer 10

heterogenous group of diseases
more cell lines can be involved-> different cytopenias in peripheral blood
clinical signs: weakness exercise intolerant, fever, hemorrhage
diagnosis: BM test

Question 11

acute lymphoblastic leukemia

Answer 11

immature lymphoblast proliferation
rapid onset, progressive, porr response to treatment
Signs: lethargy, weight loss, intermittent fever,hepatosplenomegaly, abdominal pain

Question 12

chronic lymphocytic leukemia

Answer 12

proliferation of mature lymphocyte
Signs: hepato-splenomegaly, fever, PU/PD, intermittent lameness, haemorrhage, mild lymphadenomegaly
therapy: prednisolone + chlorambucil

Question 13

treatment of non regenerative anemia

Answer 13

Treat the underlying disease
- IMHA → immunosuppression
- Ehrlichiosis → doxycyclin
- Cobalamin-deficiency → Vitamin B12 inj.
- Estrogen-toxicosis → castration ?
- Leukaemia → chemotherapy
Win time for diagnosis/ therapeutical effect→ blood transfusion