Anaemia Flashcards

1
Q

What 3 things can anaemia be define by?

A

–PCV

–Red blood cell count

–Haemoglobin

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2
Q

Name 2 normal occassions there would be a raised PCV (3)

A

Greyhounds and other sight hounds often naturally have a higher PCV (>50)

Stress/ excitement causes splenic contraction e.g. going to vets

Anabolic steroids

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3
Q

Name 2 normal occassions there is a decreased PCV (3)

A

Age – puppies and kittens< 6-12 months have a lower normal range

  • Puppies 25-34% vs adult 37-55%;
  • Kittens 24-34% vs adult 24-45%
  • Always say the age!!! They have a different reference range at the lab

ACP (relaxes splenic capsule so more RBCs in storage) – keep this in might if you use ACP to image the spleen

Reproductive status (late pregnancy)

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4
Q

Name 2 causes of regenerative anaemia

A
  • Blood loss
  • Haemolysis
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5
Q

Name the cause of non regenerative anaemia

A

Supression o erythropoiesis whether it is intra or extra marrow

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6
Q

Where and how can you get regenerative anaemia?

A

Where?

  • External blood loss
  • Blood loss into body cavity (haemothorax, haemabdomen)

How?

  • Trauma e.g. RTA
  • Coagulopathy
  • What should normally be okay is being dramatic
  • Endo or ectoparasites
  • GI blood loss (tumours, ulcers
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7
Q

What is haemolysis?

A

•Erythrocytes removed prematurely from circulation by macrophages in spleen, liver or bone marrow (extravascular haemolysis)

–Phagocytic system getting rid of them

•Destruction of erythrocytes within the vascular space

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8
Q

Name causes of haemolysis (5)

A
  • Immune mediated haemolytic anaemia (IMHA)
  • Neonatal isoerythrolysis (NI)
  • Infection (Babesia spp, Mycoplasma haemofelis)
  • Oxidative damage
    • (Heavy metals, onions, paracetamol toxicities)
    • Also oxidative damage from drugs eg paracetamol in cats.
  • Rare genetic disorders
    • Hereditary non-spherocytic haemolytic anaemia
    • Pyruvate kinase deficiency
    • Phosphofructokinase deficiency
    • Feline porphyria
    • Haemolysis in Abyssinian & Somali cats
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9
Q

Name 2 haemolytic infections

A

Mycoplasma haemofelis

Babesia ssp

(protozoon)

(bacterium)

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10
Q

What is the epidemiology of Babesia sp.?

A

Endemic in cattle in some areas in UK

Emerging infectious diseases in dogs (pet travel, climate change)

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11
Q

How can oxidants induce haemolysis?

A

–Oxidation of haem iron to form methaemoglobin (no longer carrying Oxygen)

–Oxidation of haemoglobin to form Heinz bodies

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12
Q

Name 2 things which cause oxidative damage causing haemolysis (4)

A
  • Heavy metals (Zinc, Copper)
  • Onion digestions, garlic (usually dogs)
  • Rape, kale and cabbages
  • Drugs
  • Paracetamol
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13
Q

Name 3 primary disorders of erythropoiesis (intra-marrow) (5)

A
  • Iron deficiency
  • Aplastic anaemia (damage to haemopoietic stem cells)

–Ehrlichia canis, canine and feline parvovirus, idiopathic

–Drugs including chemotherapeutics (often white cell lines affected too)

•Pure red cell aplasia – RBC just not produced

–Immune-mediated, FeLV C

•Myelofibrosis

–Scarring in bone marrow

•Myelodysplastic syndromes (MDS)

–Stem cells not forming properly usually a neoplasia

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14
Q

Name 3 secondary disorders of erythropoiesis

(extra-marrow) (5)

A
  • Anaemia of chronic disease
  • Anaemia of chronic renal failure

–Not more hormone production signalling

  • Secondary to endocrine disorders
  • Oestrogen-induced bone-marrow suppression

–Or a prolonged oestrous

•FeLV (additionally to specific disease of FeLV-C)

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15
Q

Name clinical signs of anaemia

A
  • Often absent adaptation to chronic anaemia
  • Inadequate perfusion/ oxygenation
    • Pale mucous membranes
    • Lethargy, exercise intolerance
  • Compensatory mechanisms
    • Tachypnoea
    • Tachycardia
    • (making up for lack of)
  • Other signs
    • Poor pulse quality
    • Flow murmur
    • Pica – eating weird things. Mineral based are common
  • Signs related to underlying pathology
    • Splenomegaly, lymphadenopathy, pain, icterus, melaena (due to bleeding into GI tract
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16
Q

What is different about cat mucous membranes?

A

The are naturally paler

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17
Q

What is different about clinical signs of chornic anaemia?

A

May not show signs as they are used to it

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18
Q

Name clinical signs associated with an increase in haemoglobin catabolism

A

Haemoglobinemia

Haemoglobinuria

icterus (jaundice)

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19
Q

What is this and when is it seen?

A

Icteric serum when serum bilirubin levels >20mmol/L

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20
Q

When do you see icteric tissues?

A

When seerum bilirubin levels >50 micro mol/L

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21
Q

How long might regenerative anaemia lag for?

A

2-4 days

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22
Q

What haematology diagnostic tests can we do for anaemia?

A

•Red cell parameters:

–PCV (Packed Cell volume)

–Hb (O2 carrying capacity)

–MCV (how big)

–MCHC (how pale)

–Morphology +/- Blood parasites

–Reticulocyte count

  • Platelet
  • WBC, WBC differential
23
Q

Other than haematology what other tests can we do for anaemia?

A
  • Serum biochemistry
  • Urinalysis
  • Virology
  • Faecal analysis
  • Coombs’ test
  • Coagulation profile
  • Imaging
  • Bone marrow biopsy
24
Q
A
  1. Dehydration
  2. Bilirubinaemia (jaundice) or carotene (cattle)
  3. Haemolysis
  4. Lipaemia
  5. Leukocytosis or thrombocytosis
25
Q

What should we interpret PCV with?

A

•Interpret with Total Solids:

–High TS indicates dehydration which can mask severity of anaemia.

–Normal TS indicates non-regen or haemolysis

–Low TS indicates blood loss

26
Q

What is the affect of acute blood loss on PCV and toal solids?

A

May not change for a few hours

27
Q

What mild PCV results mean?

A

Anaemia of chronic disease

Acute blood loss

28
Q

What does severe PCV suggest? (2)

A
  • Haemolysis
  • Bone marrow disease
29
Q

What blood smear features are seen with regenerative anaemia? (7)

A
  • Reticulocytes
  • Anisocytosis
  • Poikilocytosis
  • Normoblastosis
  • Howell Joly bodies increase
  • Heinz bodies increase
  • Reactive leukocytes
30
Q

RBC Indices

Possible causes

Macrocytic

Hypochromic

1

Normocytic

Normochromic

2

Microcytic

Hypochromic

3

Macrocytic

Normochromic

4

Microcytic & nucleated RBCs

5

A
  1. Regenerative anaemia (Haemorrhage or haemolysis)
  2. Non-regenerative anaemia

(Acute haemorrhage or haemolysis, anaemia of chronic disease, bone marrow suppression/destruction)

  1. Iron deficiency

(external blood loss)

  1. FeLV, myeloproliferative disease, Vit B12 and folic acid deficiency, Chemotherapy (eg. with methotrexate)
  2. Lead intoxication
31
Q

What does this smear show?

A

Regenerative anaemia

32
Q

What causes regenerative anaemia?

A

–Haemorrhage

–Haemolysis

–Oxidative injury

33
Q

What do horses and cattle show poor of on slides? What might the only change be?

A

Poor reticulocytosis

  • mild increase in MCV
34
Q

What is this?

A

Non-regenerative anaemiaNon-regenerative anaemia

35
Q

What is seen nnon regenerative anaemia?

A

•Normocytic and normochromic anaemia

–MCV, RDW, MCH, MCHC all within normal ranges

•Primary (intramarrow suppression) versus secondary (extramarrow suppression)

36
Q

Why does severe anaemia require symptomatic treatment? (2)

A

–Reduce oxygen expenditure

–Increase oxygen carrying capacity

37
Q

What would be seen with acute haemorrhage of:

A) >20% los

B) 30-40% loss

C) >50% loss

A

A) Peripheral vasoconstriction and tachhycardia

B) Reduced cardiac outut, hypotension, collapse

C) Shock and death

38
Q

How can you manage acute haemorrhage?

A
  1. Prevention of further bleeding
  2. Fluid replacement
  3. Blood transfusion support
  4. Treatment of underlying disorder
39
Q

What is the distribution of Mycoplasma haemofelis and how is it transmitted?

A

Worldwide and vertical transmission

40
Q

What are the Mycoplasma haemofelis clinical signs?

A

•Variable related to haemolytic anaemia:

–Regenerative anaemia

–Jaundice

–Pale mucous membranes

–Pyrexia, depression, weakness, anorexia, weight loss.

41
Q

What is this?

A

Mycoplasm

Blood smear with Romanowsky stain or acridine orange

42
Q

How can you treat mycoplasma?

A
  • Doxycycline first choice
    • 10mg/kg SID
    • Alkaline: beware oesophageal stricture if not swallowed properly – can scar the oesopahus.
    • “Give with or just before food” – bolus food into stomach helps
  • Enrofloxacin second choice
    • 5mg/kg SID
    • Side effect retinal degeneration and blindness
  • Treat for 2-8 weeks
  • Repeat PCR
    • clinical cure (rather than remission) may be difficult
  • Supportive tx eg transfusion may be necessary
43
Q

What is babesia?

A
  • Tick borne intracellular protozoon
  • Endemic in cattle (South west England)
44
Q

What is this?

A

Babesia spp

45
Q

What is this?

A

Ehrlichia canis

46
Q

What is Ehrlichia canis transmited by?

A

Rhipicephalus

47
Q

How can we treat oxidant anaemia?

A
  • Immediate removal of oxidative agent (induce emesis if < 4hr)
  • Activated charcoal to reduce further GI absorption
  • Supportive care
  • Monitor haematological parameters – may need transfusion
  • Paracetamol only – acetyl cysteine (dogs and cats) and ascorbic acid (cats only)
48
Q

Which species is most susceptible to copper poisoning and how does it have effects?

A
  • Sheep most susceptible
    • North Ronaldsay, Texel, Suffolk
  • Capacity for Cu storage in liver exceeded
  • Sudden release of Cu stores into circulation:
    • haemolysis
    • Liver damage
49
Q

Name feed sources high in copper

A

Silage where pig or chicken manure has been used

Brewer’s mash from copper stills

50
Q

What are clinical signs of copper poisoning?

A
  • Lethargy, anaemia, teeth grinding, polydipsia
  • Pale, icteric mms and haemoglobinuria
  • Death usually occurs 1 to 2 days after the onset of clinical signs.
  • At post-mortem, tissues are pale to dark yellow and the kidneys are a very dark color
51
Q

How can you treat copper poisoning?

A
  • Oral or injectable ammonium tetrathiomolybdate
  • Can add other copper binders, such as sulphur
  • Often expensive to treat and prognosis poor if severe
  • Diagnose, and recommend management changes
52
Q

Iron deficiency anaemia:

A) What is the aetiology?

B) How do you diagnose?

C) How do you treat?

A

A)

  • Late feature of chronic blood loss
  • Bone marrow stores deplete before anaemia develops

B)

  • Normo to microcytic, hypochromic
  • Non regenerative
  • ↑platelet count (cause unknown)
  • Red cells become fragile
  • schistocytes, keratocytes and target cells

C)

•Long term treatment required to replenish bone marrow

53
Q

Name oestrogen-inducd bone marrow supression casues (2)

A

•Persistent oestrus in ferrets

–Proligestone to end oestrus

–She isn’t mated – severe anaemia

•Oestrogen-secreting tumour

54
Q

What is the relationship between older cats and anaemia?

A
  • Common in animals with CKD
  • Reduced renal erythropoietin production
  • Check for other sources of blood loss such as GI ulcers
  • Treatment with recombinant human EPO