5 – RBC 3

Question 1

What are the types of non-regenerative (NR) anemia?

Answer 1

• **Persistently NR
  o Anemia of inflammatory disease (AID)
  o Anemia of chronic kidney disease (CKD)
  o Endocrine disease
  o Bone marrow disease
• Need time or iron
  o (acute blood loss or hemolysis)
  o (iron-deficiency anemia)

Question 2

Anemia of inflammatory disease (AID)

Answer 2

• Most common type of NR anemia
• Mild to moderate anemia (if marked=need to think of something else contributing)
• Normocytic, normochromic
• Little clinical significance
• Can develop within 3-10 days
• Any chronic disorder with an inflammatory component
  o Chronic infections: bacterial, fungal
  o Non-infectious: toxic, neoplastic

Question 3

What might the clinical “significance” of AID?

Answer 3

• Secondary to primary inflammatory disease
• Often have inflammatory leukogram (not always)
• Hyperglobulinemia, hyperfibrinogenemia

Question 4

Why does AID happen? (pathogenesis)

Answer 4

• Inflammatory cytokines lead to DECREASED IRON AVAILABILITY
  o Mediated by hepcidin
  o reduced serum [Fe]
  o More iron in storage form
  o Non-specific antibacterial immune mechanism
• *inhibited erythropoiesis
• Decreased RBC lifespan

Question 5

Iron-deficiency anemia vs AID:

Answer 5

• BOTH
  o Decrease serum [Fe]
• AID
  o Decreased transferrin
  o Increased ferritin and hemosiderin
  o Adequate iron stores
  o Body is SEQUESTRING IRON
  o Non-regenerative

Question 6

When do you think about AID?

Answer 6

• Mild to moderate anemia
• Non-regenerative
• Normocytic, normochromic
• Evidence of inflammatory disease

Question 7

Anemia of chronic kidney disease (CKD)

Answer 7

• Seen in most animals with CKD
• Mild to moderate
• Normocytic, normochromic
• Concurrent evidence of kidney disease

Question 8

Kidney disease: big picture

Answer 8

• Chemistry panel: increase urea and creatine
• Urinalysis: minimally concentrated urine
  o If less than 1.030 in dog and 1.035 in cat
• *renal azotemia
  o But if urine adequately concentrated=pre-renal origin

Question 9

Why does anemia of CKD happen?

Answer 9

• Inadequate EPO production
  o Due to kidney damage
• Decreased marrow response to EPO

Question 10

When do you think of anemia of CKD?

Answer 10

• Mild to moderate anemia
• Non-regenerative
• Normocytic, normochromic
• Evidence of CKD

Question 11

Anemia secondary to endocrine disease: hypothyroidism

Answer 11

• mild anemia
• non-regenerative
• normocytic, normochromic
• decreased T4
• **Body does NOT perceive there is anemia=new steady state
  o decreased metabolic rate and decreased O2 demand
  o decreased EPO production

Question 12

Bone marrow disease

Answer 12

• CBC findings depend on cause
• Mild to marked anemia
• Normocytic, normochromic
  o Some types are macrocytic (FeLV)
• other cell lines may be affected

Question 13

What can cause bone marrow disease?

Answer 13

• Infectious agents
• Immune-mediated destruction of precursors
• Marrow replacement (fibrosis, neoplastic cells)
• Drugs/toxins
• Radiation
• Endocrine disease
• Liver disease

Question 14

FeLV: bone marrow disease anemia

Answer 14

• Damages erythroid precursors
  o Decreased erythropoiesis and anemia
  o Defective RBC may be produced=undergo apoptosis
• *anemia maybe macrocytic

Question 15

Why might FeLV anemia be macrocytic?

Answer 15

• Defective maturation leading to decreased cell divisions
• *asynchronous maturation of nucleus and cytoplasm

Question 16

Precursor-directed immune mediated anemia (PIMA)

Answer 16

• Similar to IMHA but
  o RBC precursors destroyed in bone marrow
  o NO polychromasia
  o NO regeneration
• *bone marrow evaluation to diagnose

Question 17

Pure red cell aplasia (PRCA)

Answer 17

• Earliest precursors destroyed
• *bone marrow evaluation to diagnose

Question 18

What will you see with PIMA and PRCA? (CBC)

Answer 18

• Marked anemia
• Normocytic, normochromic
• Non-regenerative
• *worse prognosis than IMHA
  o Prolonged and aggressive immunosuppressive therapy

Question 19

Marrow replacement: bone marrow disease anemia

Answer 19

• Secondary to proliferation of neoplastic cells in bone marrow
• Evidence of neoplasia
• Pancytopenia or bicytopenias
  o NR anemia
  o Neutropenia
  o Thrombocytopenia
• *bone marrow evaluation to diagnose

Question 20

When do you think about bone marrow disease anemia?

Answer 20

• Non-regenerative anemia
• Usually normocytic, normochromic
• Bicytopenia or pancytopenia
• Unexplained increases in cell numbers
• Historical reason (ex. exposure to radiation)
• Other lab date (Ex. FeLV+)