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Lymphoreticular and Haemopoietic > Abnormalities of the Erythron > Flashcards

Abnormalities of the Erythron Flashcards

1
Q

In which animals are RBCs nucleated?

A

Reptiles and birds

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2
Q

Which animals have elliptical RBCs?

A

Camelids

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3
Q

Where are the sites of RBC production?

A 
Foetus - Liver and spleen
Neonates - Bone marrow
Growing animals - Bone marrow of all bones
Long bones - red/yellow marrow
Flat bones - remain active

Liver and spleen maintain erythropoietic capacity.

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4
Q

What is required for the production of RBCs?

A 
Stem cells
Space in the marrow
Growth factors
Iron
Cholesterol/lipids
Enzymes
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5
Q

How does the nucleus and cytoplasm change during RBC maturation? What are the stage?

A
  1. Rubriblast
  2. Prorubicyte
  3. Basophillic rubricyte
  4. Polychromataphilic rubricyte
  5. Metarubricyte
  6. Reticulocyte

As the cell matures the nucleus becomes more clumpy. Cytoplasm goes from dark to light blue, to orange

Nucleus is then extruded and becomes reticulocytes, which mature to erythrocyte.

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6
Q

What is the life span of erythrocytes in:

a. Dog
b. Cat
c. Horse, cattle

A

a. 100 days
b. 70 days
c. 150 days

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7
Q

How are RBCs usually removed?

A

Major route = senescent red cells taken up by phagocytic macrophages, components recycled.

Minor route = intravascular haemolysis

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8
Q

What is evidence for reduction in red cell mass on biochemistry?

A

Decreased:

  • Haemoglobin concentration [Hgb]
  • PCV
  • Haemtocrit
  • Red blood cell concentration [RBC]
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9
Q

What is haemtocrit?

A

Same as PCV but calculated. Relies on red cell count and volume. Less accurate.

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10
Q

What leads to decreased red cell mass?

A

Increased loss

Decreased production

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11
Q

What are the classes of anaemia?

A

Mild, moderate, severe
Regenerative vs non-regenerative
Normocytic, microcytic, macrocytic
Normochromic, hypochromic, hyperchromic

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12
Q

Describe mild anaemia…

A

Just below - 10% below normal PCV
May not affect animals until exercised
Common in animals with longstanding disease e.g. endocrine

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13
Q

Describe moderate anaemia…

A

May show weakness or be well adapted.
MM pallor, fast bounding pulses
Slow drop = easy to cope with
Fast drop - easily affected and weak

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14
Q

Describe severe anaemia…

A

PCV in lower teens downwards
Pale, weak, unable to exercise
May ned oxygen stabilisation before diagnostics
Don’t fight anaemic cats!

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15
Q

What is the difference between MCH and MCHC?

A 
MCH = (g) Content
MCHC = (g/dL) per volume of fluid i.e. bigger cells needs more haemoglobin
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16
Q

What does a hypochromic red blood cell indicate?

A

Iron deficiency/poor iron incorporation (with microcytosis)

Central pallor increases

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17
Q

Describe normocytic anaemia..

A

Erythrocyte of unremarkable size

Often associated with mild non-regenerative anaemia, acute haemorrhage

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18
Q

Describe macrocytic anaemia…

A

Regeneration - polychromatophils larger than mature RBCs
Seen in poodles
99% macrocytic are regenerative and also hypochromic

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19
Q

Describe microcytic anaemia…

A

Red cell haemoglobin concentration determinds when division stops
Iron deficiency allows an extra division
PSS, Fe, hepatic failure and akitas

If a cell is very pale, they are very thin.

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20
Q

When is macrocytosis of RBCs seen?

A

Regenerative anaemia
FeLV affected cats
In myelodysplasia
Artefact in stored blood

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21
Q

How does the body respond to a fall in oxygen tension?

A
  1. Kidneys respond to low blood O2 by releasing erythropoietin
  2. Stimulates bone marrows to increase RBC production
  3. Takes 2-3 days and younger cells increase in circulation
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22
Q

If it is regenerative, what are the potential causes of anaemia?

A

Haemorrhage

Haemolysis

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23
Q

What is the reticulocyte %?

A

1000 cells counted, reticulocytes expressed as a %

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24
Q

What is the corrected reticulocyte %?

A

Same number of reticulocytes will take up more % in a very anaemic animal

Reticulocyte % x patient PCV/normal PCV

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25
Q

When is the corrected reticulocyte % indicative of regeneration?

A

When it is >1% in dogs and >0.4% in cats.

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26
Q

What is the absolute reticulocyte concentration?

A

[RBC] x Retic %

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27
Q

Causes of external haemorrhage that increases loss of RBCs…

A

Melena
Urinary tract
Epistaxis
Post-trauma/surgery

28
Q

Describe melena…

A

Digested blood in faeces
GI ulceration/neoplasia - gradual loss of blood not always visible
Iron lost forever!

29
Q

Causes of internal haemorrhage that increases losses of RBCs…

A 
Bleeding tumours
Trauma
Into tissues
Surgery
Body will breakdown RBC outside of vessels and resorb iron
30
Q

Causes of haemolysis that increases loss of RBCs

A

Increased internal RBC destruction
Intravascular/extravascular
Normal erythrocyte damage

31
Q

Describe IMHA…

A

Immune mediated haemolytic anaemia
Anti RBC antibodies - IgG/M/A
Red cells opsonised and either lysed or phagocytosed
May aggultinate
Coomb’s test positive for anti-RBC antibody
May be severe/rapid usually strongly regenerative

32
Q

What does RBC agglutination look like on a smear?

A

Strong bond of RBCs through antibodies

Grape-like clusters that look like flakes grossly

33
Q

What is rouleaux? What does it look like on a smear?

A

Normal, especially in horses
High protein +ve charge stopes RBCs repelling each other
Looks like stacked coins

34
Q

How can you distinguish agglutination from rouleaux?

A

Add saline - the lower the drop in protein conc (dilatation) the less cells will clump together with rouleaux.

35
Q

How can you test for RBC agglutination?

A

In saline agglutination test
One drop of saline and one drop of EDTA mixed on a slide
Looks like flecking before it starts to dry if +ve

36
Q

What are ghost cells?

What are they indicative of?

A

Remnants of RBCs that have lost haemoglobin
Complement pokes holes in RBCs and haemoglobin leaks into plasma - a hallmark of intravascular haemolysis
Red/pink plasma
Membrane only

37
Q

What are spherocytes?

What are they indicative of?

A

Round, dark and dense cell with no central pallor
99% certain it is IMHA
Extravascular haemolysis - macrophages bite chunks out of RBCs and if it survives it becomes spherocyte.

38
Q

What lab findings are associated with IMHA?

A

Regenerative anaemia
Increased bilirubin
Neutrophilia, monocytosis
Platelets may be affected

39
Q

Which parasites cause haemolysis?

A

Mycoplasma haemofelis and M. maemominutum
Blood borne and increases fragility and haemolysis
Either destroys the cell itself or immune system destroys cell because of parasite

Babesia

40
Q

What does mycoplasma haemofelis look like on a smear?

A

Small rings on red blood cell surface

41
Q

How can you diagnose mycoplasma haemofelis?

A

PCR - gold standard

Blood smear

42
Q

What are heinz bodies?

Are cats or dogs more susceptible?

A

Denatured haemoglobin
Due to oxidative damage e.g. onions, paracetamol, vit K, propylene glycol
Cats >dogs
Low numbers is normal in cats

43
Q

What are eccentrocytes?

A

Haemoglobin has uneven distribution within the RBC
Oxidative damage to membrane
Dogs >cats
Horses with red maple toxicosis

44
Q

What does it mean if you see lots of eccentrocytes?

A

Damage has occurred recently/occuring now because they are quickly removed from the circulation

45
Q

What are the products of shear injury?

A

Shistocytes
Keratocytes
Accompany microangipathic damage (vasculitis/tumours narrowing vessels) as causes RBC damage when passes through

46
Q

What are acanthocytes?

A

Uneven surface projection from RBCs

Associated with splenic disease e.g. haemangiosarcoma

47
Q

What are keratocytes?

A

RBC with apposed and sealed membrane
Helmet shaped
Associated with shearing e.g. DIC, vasculitis
Seen with schistocytes

48
Q

What are schistocytes?

A

RBC fragments occur secondary to shear injury

Associated with fibrin deposition in vessels and DIC

49
Q

What inherited diseases cause abnormal RBCs?

A

Pyruvate kinases deficiency

  • Chronic
  • Severe haemolysis
  • Initially regenerative the myelofibrosis and die 1year
  • Basenjis and beagles

Phosphdructokinase deficiency

  • RBC sensitive to alkaline pH
  • Low grade haemolysis with severe episodes
  • Springers
50
Q

What is the most common cause of non-regenerative anaemia?

A

Anaemia due to inflammatory/chronic disease.

51
Q

Describe the usual presentation of anaemia of chronic disease….

A

Non-regenerative
Normocytic, normochromic
Mild, slow progressing
Fe sequestration, inflammatory mediators, shortened erythrocyte survival

52
Q

Describe renal non-regenerative anaemia…

A

Decreased erythropoeitin production
Normocytic, normochromic
Impacts QOL

53
Q

How can you treat renal non-regenerative anaemia?

A

Erythropoietin injections available but may develop Ab and wipe out own erythropoietin
Aim to increase PCV, not back to normal

54
Q

Describe endocrine non-regenerative anaemia…

A

Hypothyroidism and hypoadrenocorticism
Normocytic, normochromic
Mild
Thyroid hormone and cortisol facultative effect on RBC production

55
Q

Describe non-regenerative anaemia caused by FeLV

A 
70% of anaemic cats
Selective depression of erythropoeiesis 
Dysplasia production
Myeloproliferative disease vrowding out
Normochromic normocytic but many are macrocytic
56
Q

Describe non-regenerative marrow…

What can cause it?

A

All precursors wiped out (aplasia anaemia)
Fat, plasma cells, mast cells left
Need core biopsy

Causes:
FeLV
Oestrogen toxicity
Phenylbutazone
Chemotherpay
Unknown
57
Q

What is myelodysplasia? What would you see in the marrow?

A

Adequate cellularity in marrow but abnormal maturation/production of cells

Marrow:
Erythrocyte macrocytosis
Binucleate
Maturation defects
Giant neutrophils
Hyper segmented neutrophiles
Macroplatelets
May go onto leukaemia
58
Q

What is the difference between leukaemia and myelodysplasia?

A

Leukaemia - lots of cells produced that enter the bloodstream
Myelodysplasia - lots of abnormal cells produced that don’t survive in the blood stream

59
Q

Why do neoplastic conditions of the bone marrow causes anaemia?

A

Non-regenerative due to crowding of the bone marrow
Altered environment
Usually haemopoeitic neoplasms

60
Q

What is myelofibrosis?

A

Fibrosis of the bone marrow = response to injury
Osteosclerosis - cortical bone increases
May get marked extra-medullary haematopoiesis

61
Q

When does iron deficiency anaemia become non-regenerative?

A

Chronic cases - bone marrow runs out of iron (can usually cope for a few months)

62
Q

When does immune mediated anaemia become non-regenerative?

A

Immune mediated attack on precusors, non peripheral RBCs

63
Q

What is erythrocytosis (polycythemia)?

A

Increases in HCT, RBC count and haemoglobin

64
Q

What are the causes of erythrocytosis (polycythemia)?

A

Splenic contraction
Neoplasm
Dehydration
Increase production e.g. altitude/neoplasm

65
Q

Describe primary erythrocytosis…

A

Myeloproliferative disorder or erythroid stem cells
EPO normal or decreased
PO2 normal

66
Q

Describe secondary erythrocytosis

A

Appropriate or inappropriate
Chronic hypoxia e.g. altitude
EPO secreting tumours
EPO levels elevated

Lymphoreticular and Haemopoietic (14 decks)

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