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Anemia Flashcards

1
Q

What is Anemia?

A
  • any condition that results in a low O2 carrying capacity of blood
  • NOT a diagnosis
  • clinical sign of an underlying conditon
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2
Q

What are Clinical Signs associated with Anemia?

A
  • low oxygenation
  • lethargy
  • exercise intolerant
  • ADR
  • inappetence => anorexia
  • dehydration
  • weight loss
  • low blood (low RBCs)
  • pale mucus membranes
  • slow CRT
  • increased heart rate
  • fast, thready pulse
  • low BP
  • heart murmurs
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3
Q

Depending on the cause of Anemia, you may also see:

A
  • jaundice/icterus
  • extravascular hemolysis
  • RBCs with abnormal surfaces
  • Heinz bodies
  • RBC parasites
  • hemoglobinuria/ hemoglobinemia
  • intravascular hemolysis
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4
Q

What is the Clinical Definition of Anemia?

A

Absolute decrease in total RBC count, PCV, HB concentration or all of the above

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5
Q

What does Anemia result from?

A

Decrease or inefficient rate of production of RBC or increased rate of destruction or loss of RBCs

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6
Q

What is Non-Regenerative Anemia?

A
  • abnormal response
  • NO blood loss
  • lost senesent RBCs that aren’t being replaced
  • no new RBCs are being made
  • kidney receptors sense no Hypoxia => produce no Erythropoietin
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7
Q

What are the causes of Non-Regenerative Anemia?

A
  • Kindeys
  • Bone Marrow
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8
Q

Why are the Kidneys a cause in Non-Regenerative Anemia?

A
  • receptors aren’t detecting hypoxia
  • kidney failure: not making enough erythropoietin
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9
Q

Why is Bone Marrow a cause of Non-Regenerative Anemia?

A

not knowing to make new RBCs

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10
Q

What is Acute Hemmorhage?

A
  • losses greater than 30% of total blood
  • leads to shock and death
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11
Q

What are the clinical signs of Acute Hemmorhage?

A
  • Pulse: rapid, weak
  • BP: low, hypotension
  • MM:: pale
  • PCV: normal
  • Blood Film: normocytic, normochromic
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12
Q

How long does it take for Reticulocytes to appear in blood?

A

72 hours

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13
Q

What are the causes of Acute Hemmorhage?

A
  • Trauma
    • External: HBC, dog fights
    • Internal: surgical, blunt force, ruptured spleen
  • Coagulation Disorders (Internal or External)
    • rodenticide poisioning
  • Large Bleeding Ulcers
  • Bleeding Tumors
    • mammary tumors (most common)
    • splenic tumors
  • Occult Bleeding
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14
Q

How does Chronic Hemmorhage show on RBC Indicies?

A
  • hypochromic
  • microcytic
  • low MCV, MCHC
  • blister cells (keratocytes)
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15
Q

What type of Anemia will Chronic Hemmorhage lead to ?

A

iron deficency anemia

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16
Q

What are the clinical signs for Chronic Hemmorhage?

A
  • vague
  • ADR
  • lethargic and exercise intollerant
  • inappetence / anorexia
  • low water intake => dehydration
  • weight loss
  • HR: rapid
  • BP: low
  • Pulse: thready
  • Heart murmur
  • MM: pale
  • CRT: slow
  • cold extremities
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17
Q

What are the causes of Chronic Hemmorhages?

A
  • Parasites
    • Internal: hookworms (ancylostoma caninum), coccidia (isospora, Eimeria)
    • External: fleas, ticks, lice (blood sucking)
  • G.I Ulcers
  • Neoplasms
    • new tissue growth (tumors)
  • IBD (inflammatory bowel disorder
    • immune mediated/ allergies/ infections
  • Overuse of blood donors (research anemia)
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18
Q

What are the 2 types of Hemolysis?

A
  • Intravascular (vessels)
  • Extravascular (spleen)
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19
Q

What are the Clinical Signs of Intravascular Hemolysis?

A
  • hemoglobinemia
  • hemoglobinuria
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20
Q

What are the clinical signs of Extravascular Hemolysis?

A
  • jaundice
  • icterus
    • buildup of unconjugated Bilirubin. fat soluble
  • splenomegaly
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21
Q

What clinical signs can also sometimes occur in Intravascular Hemolysis?

A
  • jaundice
  • icterus
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22
Q

What are the causes of Hemolysis?

A
  • Immune mediated
  • Heinz Body Anemia
  • Microorganisms
  • Drugs
  • Water Intoxication
  • Microangiopathic Hemolysis
  • RBC Defects
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23
Q

What is IMHA?

A

immune mediated hemolytic anemia

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24
Q

What RBCs are seen in IMHA?

A
  • spherocytes
  • agglutination => hemolysis
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25
What are the 2 causes of IMHA?
- primary - secondary
26
What are the primary causes of IMHA?
-idiopathic
27
What are the secondary causes of IMHA?
- vaccine reactions - drug therapy - neoplasia - infection
28
What is the "Hallmark" of IMHA?
spherocytes (spherocytosis)
29
What is the Coomb's Test?
serum test used to detect auto antibodies
30
What are the ranges of IMHA?
mild -\> moderate -\> acute/severe
31
What is the Prognosis of IMHA?
- depends on severity of the disease - also look at causes
32
What is the Mortality Rate of IMHA?
20-75%
33
What are the treatments for IMHA?
- steroids - prednisolone - cyclosporins - fluid therapy - blood transfusions - heparin therapy
34
What are the problems of using sterioids to treat IMHA?
- may cause secondary infections - supresses immunity
35
When is Heparin therapy used for IMHA?
when worried about pulmonary thromboembolism
36
What is Neonatal Isoeryhrolysis?
- cat drawing - uncommon in dogs - "fading kitten syndrome"
37
What is Fading Kitten Syndrome?
- bacteria, viral, fungal infections - congenital malformations - neonatal isoerythrolysis
38
What blood type are most cats?
type A
39
What is in Colostrum?
- antibodies - nutrients
40
How many blood types are there in dogs?
19
41
What is the most common blood type in dogs?
DEA 1.1
42
What type of dogs have DEA 1.1?
- lab retievers - golden retrievers
43
What type of dogs are good donors?
dogs with up ears
44
How do you determine Major Blood Type crossmatches?
- mix donor RBCs with recipent plasma - look for hemolysis
45
How do you determine Minor Blood Type crossmatches?
- mix donor plasma with recipent RBCs - observe for agglutination
46
What are the causes of Heinz Body Anemia?
- plants - onions and garlic - baby food - drugs and toxins - diseases in cats
47
What % of Heinz Bodies are cats born with?
5%
48
What type of Drugs and Toxins cause Heinz Bodies Anemia?
- acetaminophen (tylenol) - propofol - napthelene (moth balls) - propylene glycol - zinc and copper (pennies, vitamins, sunblock) - benzocaine (topical anesthetic) - crude oil (motor oil)
49
What cat diseases cause Heinz Bodies Anemia?
- hyper thyroidism - diabetes mellitus - lymphoma
50
What Microorganisms cause Hemolysis?
- protozoal blood parasites - bacteria - viruses
51
What Protozoal Blood Parasites cause Hemolysis?
- hemotropic microplasms - babesia species - cytauxzoon species
52
What type of Bacteria causes Hemolysis?
- ehrlichia canis - leptospira species - clostridium species
53
What type of Viruses cause Hemolysis?
- EIA (equine infectious anemia) - FeLv - FLV
54
What kind of Drugs cause Hemolysis?
- fenbendazole (panacur) - heparin
55
What are the types of Water Intoxication that cause Hemolysis?
- psychogenic polydypsia - fluid admin miscalculations - water disease in cats
56
What is Microangiopathic Hemolysis?
turbulent / abnormal blood flow through vessels
57
What does Microangiopathic Hemolysis result from?
- heartworm disease (microfliaremia) - hemangiosarcoma - D.I.C (fibrin strands causing schistocytes)
58
What are the 2 types of RBC Defects?
- congenital (hereditary) membrane defects - nutritional defiencies
59
What is an example of a Congenital Membrane Defect?
-congenital stomatocytosis
60
What are Nutritional Deficencies?
- iron (keratocytes) - copper - vitamin B - hypophosphatemia - inhibits RBC glycolysis
61
What are the causes of Hypophosphatemia?
- diabetes mellitus - parenteral feeding
62
What is Non-Regenerative Anemia?
- evidenced as a lack of circulating RBCs in the face of anemia - no replacement of senscent RBCs
63
How does Non-Regenerative Anemia show up on a blood film?
- normocytic - normochromic
64
What does Non-Regenerative Anemia result from?
decrease or defective erythropoiesis
65
What are the causes of Non-Regenerative Anemia?
- nutritional deficencies - chronic disease - renal disease/failure - bone marrow disorder/disease
66
What Chronic Diseases are secondary to infection?
- canine parvovirus - ehrlichiosis - FeLv / FIV - inflammation - neoplasia - liver disease - hypothyroidism - addison's - cushings
67
What is Renal Disease / Failure?
- produces no erythropoietin - receptors arent' detecting hypoxia -
68
What are examples of Bone Marrow Disorders/ Diseases?
- aplastic anemia - pure RBC aplasia - leukemia - myelodysplasia - myelofibrosis
69
What is Aplastic Anemia?
- bone marrow stops producing - idopathic
70
What can Aplastic Anemia be secondary to?
- infections - drug therapy - toxins - irradiation
71
What is the treatment for Aplastic Anemia?
- bone marrow transplants - blood transfusions - antibiotics (for prevention: prophylaxis)
72
What is Pure Red Blood Cell Aplasia?
- occurs with IMHA - auto antibodies are directed against RBC precursors in the marrow - autoimmune problem
73
What does Pure Red Blood Cell Aplasia result from?
- FeLv - continued treatment with recombinant erythropoietin
74
What are treatments for Pure Red Blood Cell Aplasia?
immunosuppresent therapy (steriods)
75
What is Leukemia?
- rare - abnormal proliferation of 1 or more WBC lines - can be chronic or acute
76
What are the characteristics of Chronic Leukemia?
- usually 1 line of WBCs are effected - responds well to treatment
77
What are the characteristics of Acute Leukemia?
-more than 1 line of WBCs affected
78
What is the Mean Survival Time of Acute Leukemia?
- about 4 months - usually results in panleukopenia - low RBCs and platelets
79
Why do patients with Acute Leukemia become immunocompromised?
- mostly circulating blast cells - have no granules - they are useless WBCs
80
What is Myelodysplasia?
-"pre leukemic syndrome"
81
What does Myelodysplasia result from?
- FeLv - mutation in stem cell lines - neoplasia - drug therapy
82
What is the survival time for Myelodysplasia?
- variable - depends on what type of leukemia and progression - usually progresses into leukemia
83
84
What is the Bone Marrow Response in Regenerative Anemia?
- bone marrow is responding appropriately to blood loss - increased production and delivery of immature RBCs into circulation
85
How long does it take for new immature RBCs to enter the blood stream?
72 hours
86
How is Regenerative Anemia see on a Blood Film?
- anisocytosis - polychromasia - reticulocytosis - nucleated RBCs
87
How does Regenerative Anemia show up on RBC indicies?
- Macrocytosis (increased MCV) - Hypochromasia (decreased MCHC)
88
How is Regenerative Anemia verified?
Absolute Reticulocyte Count
89
What is Mtelofibrosis?
-bone marrow elements are replaced with fibrous tissue
90
Myelofibrosis can be primary or secondary to:
- irradiation - drug therapies - IMHA
91
What is the treatment for Myelofibrosis?
immunosuppression
92
What are the types of Secondary Bone Marrow Damage?
- radiation - cytotoxic drugs - chloramphenical - estrogen toxicity - other drugs
93
What types of Radiation cause Secondary Bone Marrow Damage?
- cancer treatment - xray radiation
94
What type of Cytotoxic Drugs cause Secondary Bone Marrow Damage?
chemotherapy
95
What is Chloramphenical?
- antibiotic - harmful especially to cats - also harmful to person administering drugs
96
What type of Estrogen Toxicity causes Secondary Bone Marrow Damage?
-hyperestrogenism
97
How does an animal get Hyperestrogenism?
- getting into owners B.C. pills - estrogen pills
98
How do you identify the underlying causes of anemia?
- paitents history/owners chief complaint - physical exam findings - lab test results - results of other tests
99
What questions do you ask to find out the Patient History/CC?
- time of onset of C/S? - evidence of blood loss? - exercise intolerance? - existence of underlying condition? - exposure to drugs? - exposure to environmental toxins and chemicals?
100
What does Abrupt Onset of C/S suggest?
- regenerative anemia - caused by: - acute blood loss - hemolysis
101
What does Gradual Onset of C/S suggest?
- non-regenerative anemia - caused by (NRA): - bone marrow - kidneys - caused by (RA): - chronic blood loss - hemolysis
102
What are examples of Evidence of Blood Loss?
- hematuria - melena or frank blood - hemoptysis - hematemesis
103
What is Hematuria?
- hemoglobinuria - increased intravascular hemolysis
104
What is Melena Blood?
- tarry, black, coffee ground stool - results from digested blood
105
What causes Melena Blood?
upper GI bleeding
106
What is Frank Blood?
-bright red
107
What causes Frank Blood?
- coccidia (chronic blood loss RA) - parvovirus (RA -\> NRA)
108
What does Frank Blood mean?
lower GI bleeding
109
What causes Hemoptysis?
- URI (RA) - resp. parasites (RA) - neoplasia (RA) - ehrlichiosis
110
What causes Hematemesis?
- upper GI bleeding - ulcers - neoplasia - parasites
111
What does Exercise Intolerance result from?
low oxygenation
112
What does Exercise Intolerance occur with?
-chronic anemia
113
What does recent Weight Loss suggest?
chronic anemia
114
Fenbendazole and Heparin
- causes:heinz bodies - RA - extravascular hemolysis
115
Propofol
- heinz body anemia - RA
116
Benzocaine
- heinz body anemia - RA
117
Birth Control Pills
- estrogen toxicity - NRA
118
Chloramphenicol
NRA
119
Multivitamins
- hemolysis - RA
120
Vaccines
- acute vaccine reaction - reaction causes IMHA - RA -\>NRA
121
What are examples of Environmental Toxins and Chemicals?
- plants - lead, zinc, copper, iron - rodenticides
122
What types of plants are Environmental Toxins and Chemicals?
- onions and garlic: H.B.A (RA) - sago palms: hemolysis and death
123
Lead, Zinc, Copper, Iron
hemolysis
124
Rodenticides
- coagulapathy -\> acute blood loss - RA
125
What things do you check when doing Physical Examinations?
- fever - pulse/HR - mm/CRT - palpations - physical signs of underlying disease - external wounds
126
What does a Fever indicate?
- infection (acute or chronic) - leukemia
127
What Pulse/HR indicates Anemia?
- pulse: thready, weak but fast - HR: tachycardia
128
What CRT indicates Anemia?
prolonged, greater than 2 seconds
129
What does a pale mm mean?
decrease number of RBCs
130
What does a yellow mm mean?
-icterus (liver diease, increase extravascular hemolysis)
131
What does a pale and yellow mm mean?
hemolysis (extravascular)
132
What does a blue mm mean?
cyanotic
133
What causes Petechia or Ecchymoses in mm?
- rodenticides - coagulations - Von Willebrans - thrombocytopenia
134
What are you looking for during palpation?
- splenomegaly - hepatomegaly
135
What are Physical Signs of Underlying Diseases?
- hyperestrogenism - hypothyroidism - cushing's
136
What Physical Sign does Hyperestrogenism, Hypothyroidism and Cushing's show?
bilateral symmetrical alopecia
137
What are examples of External Wounds?
- HBC - gunshot - dog fight
138
What tests are run during Laboratory Evaluations of Anemia?
- total RBC count - PCV - Hb concentration - RBC indicies - blood smear - reticulocyte count - total WBC count - total protein concentration - bone marrow evaluation
139
How does Iron Deficency Anemia show on a Hb concentration test?
- hypochromic - normocytic - schistocytes - keratocytes
140
What does Iron Deficency Anemia result from?
- chronic blood loss - nutritional defiencies
141
What does a increase in total WBC count mean (with blast cells)?
- leukemia - blast cells - NRA
142
What does an increase in total WBC count mean (without blast cells)?
- infection - RA or NRA
143
What does a decrease in total WBC count mean?
- immunosuppression (bone marrow) - NRA
144
What does a increase in Total Protein Concentration mean?
- kidneys affected - NRA
145
What does a decrease in Total Protein Concentration mean?
- liver disease - acute: RA (hemolysis) - chronic: NRA
146
When do you do a Bone Marrow Evaluation?
-MUST be done when you have unexplained NRA
147
What are you looking for when doing a Bone Marrow Evaluation?
- blast cells - RBC precursors - can be done by aspirate or biopsy procedure
148
What are other tests that can be run and what can they find?
- xrays (pennies) - ultrasound (neoplasia) - SNAP tests (parvo, etc) - fecals (parasites)

Clin Path (8 decks)

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