4.3.4: Anaemia - diagnosis and management Flashcards
Reticulocytes present in significant numbers on an anaemic dog’s blood smear are indicative of what process?
a) acute, severe haemorrhage
b) bone marrow disorder
c) regenerative anaemia
d) red blood cell fragmentation, destruction or damage
e) oxidative damage e.g. due to paracetamol toxicity
c) regenerative anaemia
What would be the an appropriate initial treatment protocol for a 3 y.o. cat who presents clinically stable with pyrexia 39.6C, PCV 18%, positive saline agglutination and smear as below?
a) blood transfusion with packed RBCs
b) immunosuppressive doses of glucocorticoids
c) doxycycline
d) N-acetylcysteine
e) Vitamin K injections
c) doxycycline
The parasite shown is Mycoplasma haemofelis
Glucocorticoids would not be appropriate in pyrexic animal - MUST rule out infection before giving these!
Which of the following sets of lab findings would be most consistent with an acutely bleeding splenic haemangiosarcoma?
a) PCV 25%, numerous schistocytes and acanthocytes
b) PCV 30%, polychromasia and many reticulocytes
c) PCV 5%, thrombocytopaenia and autoagglutination
d) PCV 15% with numerous spherocytes
e) PCV 12% with numerous Heinz bodies in the red blood cells
a) PCV 25%, numerous schistocytes and acanthocytes
* Suggests neoplasia
b) PCV 30%, polychromasia and many reticulocytes
* Suggests regenerative anaemia
c) PCV 5%, thrombocytopaenia and autoagglutination
* Suggests bleeding
d) PCV 15% with numerous spherocytes
* Suggests IMHA
e) PCV 12% with numerous Heinz bodies in the red blood cells
* Usually associated with toxic change
You are presented with a 5 y.o. Lab with anaemia, PCV 21%. You perform a smear, shown below. What do you suspect is the cause of anaemia in this dog?
a) Rodenticide toxicity
b) Thrombocytopaenia
c) Von Willebrand’s disease
d) IMHA
e) Babesia canis infection
d) IMHA
Emergency stabilisation of the anaemic animal
- Oxygen supplementation
- Temperature management
- Fluid therapy e.g. IV fluids, blood transfusion as indicated
- Analgesia in the event of trauma
- Investigation of and specific therapy for root cause/ concurrent conditions e.g. PCV + blood smear, TFAST, rads, abdo US, biochem and haematology, infectious disease screen
- Emergency surgery if warranted e.g. for bleeding haemangiosarcoma, splenic rupture, arterial bleeds
How should you deliver fluid replacement therapy in the acute patient?
- Inadequate circulating volume will kill the patient first -> replacement of fluid volume with isotonic fluid is often more important than correction of oxygen carrying capacity
- Fluid replacement should be carried out in a response-driven manner i.e. 5-10ml/kg at a time, assess cardiovascular parameters, and judge if repeat needed
- Beyond the peracute phase, moderate to severe anaemia -> need to rectify oxygen-carrying capacity with blood products
What cardiovascular parameters can you assess to see if your patient needs more fluids?
- Heart rate
- Pulse quality
- CRT
- Blood pressure
Fresh whole blood
- Collected and administered within 8 hrs
- Contains all blood components including platelets and clotting factors
- Generally used for acute blood loss/ active bleeding
Stored whole blood
- Stored (<4C) and used >8hrs later
- No platelets and less clotting factors (factors V, VIII and vWF are unstable and will be gone)
- Generally used for acute blood loss/ bleeding
Packed RBCs (pRBCS)
- RBCs in nutrient solution
- No platelets or clotting factors
- Stored for 1-2 months
- Good for anaemic animals that have low tissue oxygenation
Fresh frozen plasma (FFP)
- Collected, processed and stored within 24hrs
- Can be stored ~1 yr
- Contains all clotting factors
- Good for use in coagulopathies
Frozen plasma (FP)
- i.e. not fresh
- Frozen >24hrs after collection OR is FFP stored for >1 yr
- Will not store labile clotting factors
- Good for use in coagulopathies that require non-labile clotting factors
True/false: platelets are available as a product in the UK.
False.
Not currently available in the UK.
How is Mycoplasma haemofelis transmitted?
Mycoplasma haemofelis: worldwide, blood-borne pathogen that affects RBCs.
* Transmission is by fleas and ticks, and vertically
* Disease process is waxing and waning
* Carrier states exist and may be very critical to transmission and life cycle
Clinical signs of Mycoplasma haemofelis
May be asymptomatic, or may be severely anaemic, jaundiced animals
* Young animals/ immunosuppressed animals are more prone to severe disease
* Pyrexia
* Lethargy
* Anorexia
* Weight loss
* Pale mm
* Jaundice
Diagnosis of Mycoplasma haemofelis
- Blood smear: Romanowski stain or acridine orange
- PCR is more sensitive
- Sample when sick and before beginning treatment to minimise chance of false -ves (possible due to carrier state/waxing and waning disease process)