Anemia Flashcards
Diagnosis of non regenerative anemia
Biochemical Profile
Bone Marrow Aspirate
Bone Marrow Aplasia
No red cell production
Clinical signs associated with blood destruction
Splenomegaly
Icterus
Hemoglobinuria
Treatment for IMHA
Glucocorticosteroids
Other immunosuppressive drugs
Fluids
Correct acidosis
Pyruvate kinase deficiency results in
Impaired energy metabolism with resultant increased red blood cell destruction
Causes of Aplastic anemia
Infectious agents
Immune mediated destruction
Drugs and chemicals
In methemoglobinemia - blood appears chocolate brown when _______% of hemoglobin is methemoglobin.
Death occurs when concentration is ______%.
30%
90%
Copper Toxicosis causes
Hemolytic anemia
Hemoglobinemia/hemoglobinuria
Heinz body formation
Oxidative damage
Anemia of inflammatory disease
Mild to moderate
Low serum iron
Increased storage iron
Erythroid suppression may be due to unavailability of iron or inflammatory cytokines
Regenerative anemia is caused by either
Blood loss
or Blood destruction
Mycoplasma wenyonii
Cattle
Severe anemia only in splenectomized or immunosuppresed
Iatrogenic transmission
Clinical signs of mycoplasma haemocanis
Anemia signs
May look like IMHA
Icterus occassionally
Laboratory Findings for IMHA
Thrombocytopenia
Inflammatory Leukogram
Azotemia
Spherocytosis
T/F: Blood Loss causes thrombocytopenia
False
Mycoplasma Haemocanis
Opportunist, usually only in splenectomized or immunosuppressed dogs
Blood destruction or blood loss?
Immune mediated hemolytic anemia
Heinz body anemia
RBC parasites
Blood destruction
Differential diagnosis for Spherocytosis
Previous mismatched blood transfusion
Rattlesnake evenomation
Heinz body anemia - horses
Zinc toxicosis
Bee sting
IMHA
Acute or Chronic blood loss?
Trauma and Surgery
Coagulation Disorders
Bleeding Tumors
Thrombocytopenia
Acute
Diagnosis of Iron Deficiency Anemia
Anemia
Low Serum Iron
Microcytosis
Treatment for Mycoplasma haemocanis
Doxycycline
Blood loss from what organ is most common?
Intestine
Anemia due to renal disease
Insufficient erythropoietin
Uremic toxins
Excess PTH
Hypocalcemia
Bleeding tendencies
Feline Cytauxzoonosis
Protozoan
RBC phase and tissue phase
Transmitted by ticks
Almost always fatal
IMHA is commonly associated with what drugs
Penicillin
Cephalosporins
Trimethoprim-Sulfa
Levaminosle
Mycoplasma haemosuis
Severe anemia in baby pigs
Poor weight gain in adult pigs
Pyruvate Kinase Deficiency in cats
No ultimate osteosclerosis
Can live to old age
Acute or Chronic blood loss?
GI Ulcer
Bleeding GI tumor
Blood consuming parasites
Chronic
Infectious agents that can cause aplastic anemia
FeLV
Ehrlichia canis
Equine Infectious Anemia
Babesia and Theileria cause anemia by what mechanism?
Intravascular hemolysis
Hypothyroidism
Mild anemia
Decreased metabolic rate
Uroporphyrinogen III Co Synthetaste Deficiency in Cats
“Porphyria” “Pink Tooth”
Autosomal Dominant
No anemia
Plants that can cause Heinz body anemia
Onions, Garlic
Kale, Cabbage, Rape
Wilted Red Maple Leaves
Bacterial induced hemolysis
Clostridium perfringens type A
Clostridium haemolyticum
Endocrine diseases that can lead to anemia
Hypothyroidsim
Hypoadrenocorticism
Phosphofructokinase Deficiency
Autosomal Recessie
Decreased synthesis of 2,3 diphosphoglycerate
PCV normal
Hemolytic crisis when alkalemic
Treatment of Iron Deficiency Anemia
Find cause and source of blood
Injectable iron - neonates
Characteristics of acute blood loss
Protein decreases along with PCV
Erythrocyte morphology usually normal
Pathogenesis of Anemia of Inflammatory Disease
- LPS and IL6 induce hepatic production of Hepcidin (regulator of iron homeostasis)
- Hepcidin inhibits cellular efflux of iron by binding to and inducing internalization and degradation of ferroportin
- LPS down regulates divalent metal transporter expression - inhibition of duodenal iron absorption
- LPS down regulates ferroportin expression - decreased iron release from iron stores
- Cytokine upregulate DMT1 on macrophages - increase iron uptake
- IL10 increase transferrin receptors on macrophages - increase iron uptake
- TNF -alpha, IL 1,6, 10 upregualte ferritiin expression - promote storage and retention
_______________________________________
Overall result in decrease iron in transport and functional pools limiting iron for erythropoiesis
Anemia is caused by
Increased loos
Increased destruction
Decreased production by marrow
or come combination of the above
Treatment for Mycoplasma haemofelis
Blood transfusion
Prednisone
Doxycycline
Enrofloxacin
Anemia
Decrease in red blood cell mass, resulting in decreased oxygenation of tissues
Immune Mediated Aplastic Anemia
Antibodies directed against stem cells
May be drug induced or idiopathic
Pyruvate Kinase Deficiency in dogs
Moderate to marked anemia
Marked reticulocytosis
Myelofibrosis, sclerosis
Death by age 4
Drugs and Chemicals that can cause Heinz body anemia
Acetaminophen
Propylene glycol
Zinc
Copper Selenium Deficiency
Methylene Blue
Crude Oil
Naphthalene
Clostridium perfringins Type A
“Yellow Lamb Disease”
Hemolytic anemia in lambs and calves
Blood destruction occurs due to
Intravascular hemolysis
or
Extravascular hemolysis
Immune Mediated Hemolytic Anemia
Often secondary associated with infection, modified live virus vaccination, neoplasia and drugs
T/F: If agglutination is present, Coombs test is not indicated.
True
Uroporphyrinogen III Co Synthetase Deficiency in cattle
“Porphyria” “Pink Tooth”
Inability to synthesize hemoglobin with accumulation of uroporphyrin and coprophyrin in bones, teeth
Pigemented fluorescent teeth and bones
Photosenstitivity
Decreased RBC survival
Clostridium haemolyticum
“Bacillary Hemoglobinuria” “Red Water Disease”
Cattle
Associated with liver fluke migration
CS: anemia, arched back, blood diarrhea, fever, dyspnea, hemoglobinuria
Uroporphyrinogne II Co Synthetase Deficiency in pigs
“Porphyria” “Pink Tooth”
No photosensitization
Autosomal Dominant
IMHA in cats is commonly associated with
Mycoplasma haemofelis
FeLV
Neoplasia
Drugs and chemicals that can cause aplastic anemia
Antineoplastic, immunosuppressive drugs
Toxins
Estrogen in dogs and ferrets
Mycoplasma haemofelis
Transmitted through infected blood by blood feeding arthropods, cat bites, and iatrogenic exposure
Diagnsosis by blood film exam or PCR
Regenerative Anemia
Hypoadrenocorticism
Mild anemia often masked by dehydration
Mechanism unclear
Band 3
Protein that exchanges bicarbonate ion for chloride ion in erythrocytes, thus greatly increasing capacity of blood to carry CO2
Also important in maintaining cell shape
Anaplasmosis
Tick borne
Can cause fatal hemolytic anemia
Immune mediated destruction
Diagnose with blood film or PCR
Virus induced hemolysis
Equine Infectious Anemia - Swamp Fever
IMHA in horses is commonly associated with
Penicillin
Clostridial Infections
Neoplasia
Theileriosis
Protozoan
Cause hemolytic anemia
Stage within RBC is merozoite
Hemolytic Anemias due to Enzyme Deficiencies
Glucose 6 Phosphate Dehydrogenase
Pyruvate Kinase Deficiency
Phosphofructokinase Deficiency
Uroprphyrinogen III co synthetase
Erythrocyte parasites cause anemia by what mechanism?
Immune mediated
Cause of methemoglobinemia
Iron in ferric state - incapable of carrying oxygen
Oxidative compounds result in excessive formation
Water Intoxication
Cattle
Unlimited access to water following unavailability
Decreased osmolality leads to hemolysis
Iron deficiency anemia in adult animals is likely due to
Chronic blood loss
Disadvantages of Coomb’s Test
Many false positives
Many false negatives
Evan’s Syndrome
Immune- mediated thrombocytopenia
Laboratory findings for Iron Deficiency Anemia
Microcytosis
Reticulocytes have decreased MCV
RDW - increased
MCHC - normal
Keratocyte formation
Increased central pallor
Regenerative
Thrombocytosis
Serum iron - decreased
Transferrin - decreased
Storage iron - decreased
Total iron binding - normal
Clinical signs of anemia
Pale mucous membranes
Lethargy, reduced exercise tolerance
Increased respiratory rate, dyspnea
Increased heart rate
Murmurs if <20% - increased turbulence
Bone Marrow Hypoplasia
Red cell production decreased
Laboratory tests that should be run for anemia
Red blood cell mass (PCV)
Mean cell volume
Reticulocyte count
Total protein
Red blood cell mass is measured by
PCV
RBC count
Hemoglobin concentration
Methemoglobinemia
Acetaminophen Toxicity - Cats
Nitrate Poisoning - Cows
Rad Maple Leaf Ingestion - Horses
Congenital Deficiency of NADH-Methemoglobin Reductase
Clinical signs or Mycoplasma haemofelis
Anemia signs
Splenomegaly
Fever
Lethargy
Icterus
Aplastic Aneima
General Marrow Suppresion or failure
Heinz Body Anemia
Oxidatively denatured hemoglobin
Causes of intrinsic erythroid hypoplasia
Myelodysplasia
Leukemia
Immune-mediated destruction of erythroid precursors
Hemolysis due to inherited membrane defects
Hereditary: spherocytosis
elliptocytosis
stomatocytosis
membrane transport defects
Babesiosis
Large and small types
Transmitted by ticks
Cause severe disease and hemolytic anemia
May be mistaken for IMHA
Iron deficiency anemia in nursing animals is typically due to
Inadequate intake
Neonatal Isoerythrolysis
Maternal antibodies against the neonates blood group antigen attach to the neonates RBCs with subsequent RBC hemolysis
Causes of Erythroid Aplaisa
Immune Mediated destruction of RBC precursors
Feline Leukemia Virus
Mycoplasma haemolamae
Opportunist
Causes mild anemia
Heinz body anemia occurs with what diseases
Lymphoma
Hyperthyroidism
Diabetes Mellitus
Cuases of extrinsic erythroid hypoplasia
Chronic renal disease
Endocrine disorders
Inflammatory disease
Diagnosis of erythrocyte parasites
Blood film examination
PCR assays
When should a Coombs test be run for IMHA?
No Spherocytes
In species where it is hard to detect Spherocytes
Pathogenesis of heiz body formation
- Hemichrome formation due to oxidative damage
- Hemichromes aggregate into bits of denatured hemoglobin
- Sulfhydral groups are susceptible to oxidative damage
- Hemichromes form complexes with protein band 3 - clustering of band 3 creating recognition site for auto-antibodies
- Spectrin-hemoglobin cross linking - increase membrane rigidity
Differential diagnosis for Microcytosis
Portosystemic shunt
Breed predisposition
Anemia of inflammatory disease
Iron deficiency anemia