Anemia Flashcards
What are the 3 main causes of anemia?
Increased loss (hemorrhage) Increased destruction (hemolysis) Decreased production by marrow
Or combo of these
What are clinical signs of anemia?
Pale mucous membranes
Lethargy
Increase resp rate, dyspnea
Increased heart rate
Spenomegaly, icterus, and hemoglobinuria are clinical signs associated with ??
Blood destruction
What 4 tests would you used to assess an anemia?
PCV- Red blood cell mass
Mean cell volume
Recticulocytes count
Total protein
What test do you used to confirm IMHA?
Coombs test
an anemia with a high reticulocyte count tells you what??
Bone marrow is responding (regenerative anemia)
-anemia due to blood loss or blood destruction
What can you use to differentiate if an anemia is due to destruction or blood loss
Total protein
Low TP-> blood loss (acute)
In a dog..
PCV 13%
Rectics 100,000 (high)
TP 5.0 (low)
Hematology -> acanthocytes and schistocytes
Hemangiosarcoma
-> acute blood loss due to rupture
What are common causes of chronic blood loss?
GI ulcers
Bleeding GI tumors
Blood consuming parasites
In adults, and iron deficiency anemia is almost always due to ???
Chronic blood loss
PCV 15%
Reticulocytes high
Microcytosis
RDW is increased
Histopathology -> keratocytes and increased central pallor
Regenerative anemia
Microcytosis and keratocytes are evidence of….
iron deficiency anemia
How does the therapy differ in adults and neonates for iron deficiency anemia?
Adult- > find source of chronic bleed
Neonate -> injectable iron
Microcytosis can have multiple causes .. what are they?
Portosystmic shunt
Breed predisposed
Anemia of inflammatory disease
Iron deficiency anemia
Case : 10yr old yellow lab
4months earlier: PCV 44% and TP 8.2
PCV 16% Rectics 342 (range 0-60) TP 6.2 (range 6.0-8.0)
What would you suspect?
Anemia due to blood loss
High reticulocyte count => regeneration
TP - is within range but much lower than it was at a check up 4months ago
CASE - 1yr old female pointer
History of back pain, vomiting, previously treated with steroids for the back pain
PCV: 18% MCV 47 (60-72) MCHC 33 (34-38) Rectics 18.8 (0-60) TP 5.9 (6-8) Inflammatory leukogram Hematology-> keratocytes, schistocytes, blister cells, and giant platelets
MCV is low -> microcytosis
Rectics 18.8(relatively low)-> non regenerative
TP minorly low-> chronic blood loss
MCV and keratocytes/schistocytes –> Iron deficiency
Chronic blood loss
- GI ulcer
- hookworms
In cats, immune hemolytic anemia is often associated with what conditions?
Mycoplasma hemofelis
FeLV
Neoplasia
In horses, immune mediated hemolytic anemia is associated with ??
Penicillins, clostridial infections, and neoplasia
What species of dogs do we see the highest incidence of IMHA?
Cocker spaniels
Also in poodle and collies
What is the diagnostic test for immune mediated hemolytic anemia?
Coombs test (Direct antiglobulin test)
In IMHA, antibodies are binding to RBCs
Coombs adds and antibody against the IgG –> cause agglutination in positive animals by binding the IgG which is bound to RBCs
Does Dr Thrall like the Coombs test? Why or why not?
Nope
Many false negative -> immune competes attached to erythrocytes but destruction of RBC is not increased
Many false positives -> low concentration of AB of RBC
What is your DDx for spherocytosis?
Previous mismatched blood transfusion
Rattlesnake envenomation
Heinz body anemia in horse
Zinc toxicosis
Bee stings
What do you call the disease of having both an immune mediated hemolytic anemia AND immune mediated thrombocytopenia ?
Evans syndrome
In IMHA, the leukograms almost always is _____
Inflammatory
What is the therapy for IMHA?
Glucocorticosteriods (decrease AB production, Tcell activity, and macrophage function)
Fluids
Correct acidosis
Blood transfusion and splenectomy are not usually indicated
How can zinc toxicosis result in spherocyte formation?
Band 3 is a protein that exchanges bicarbonate ion for chlorine in RBCs -> zinc results in clustering of the protein -» rounding of cell
What is a common cause of IMHA in horse/mule foals?
Neonatal isorytholysis
-maternal AB against the neonates blood group bind the foals RBCs -> hemolysis
Will see the foal become weak after ingesting colostrum
What erythrocytes parasites cause intravascular hemolysis
Babesia and Theileria
-> AB against parasites –> complement fixations and phagocytosis my macrophages
What is a common cause of serious anemia in cats and can be a cause of IMHA. How does the cat get this?
Mycoplasma hemofelis
Transmitted through blood feeding anthropoids/cat bites/ iatrogenic exposure
Cat..
Anemia Splenomegaly Fever Lethargy Icterus
Blood smear shows small eosinophilic dots on the peripheral of the RBCs
mycoplasma hemofelis
Mycoplasma hemofelis will cause a regenerative anemia exception in what cases?
There is underlying disease like FeLV or severe inflammatory disease
In a doggo..
Blood smear shows eosinophilic line of dogs in the RBCs and you also see a Howell jolly body
M. Hemocanis
What mycoplasma is found in cattle and only causes sever anemia in splenecomized or immunosuppressed animals?
M. Wenyonii
What parasite of RBCs can cause a severe anemia in baby pigs and in adults is associated with poor weight gain
Mycoplasma hemosuis
Tick borne rickettsial infection of ruminants that can cause fatal hemolytic anemia
Anaplasmosis
A. Marginale and A. Centrale
Hemoprotozoan organism that is transmitted by ticks and blood transfusions causing severe disese and hemolytic anemia
Babesia sis
Babesia sis in horses is usually called??
Piroplasmosis
Theileriosis is a protozoan causing hemolytic anemia in what sp?
Ruminants
What stage of the theileriosis organism is in the RBC
Merozoite (piroplasm)
T/F: blood smear of a deer, the RBCs are sickle shaped therefore they have sickle cell anemia
FALSE ..
all the other clinical pathologist will laugh at you and will never respect you again, if you say this
This shape change is normal change that occurs in vitro due to changes in oxygen concentration
Protozoan of cats that has a piroplasm RBC phase and a schizont phase in the macrophages in tissue
Feline cytauzoonoisis
What is a heinz body anemia?
Oxidatively denatured hemoglobin
What plants can form heinz body aneimia?
Allium (onion and garlic)
Brassica (kale, cabbage, rape)
Wilted red maple leaves
What drugs/chemicals can cause heinz body formation?
Acetaminophen Propylene glycol Naphthalene Crude oil Methylene blue
Zinc
Copper selenium deficiency
How are heinz bodies formed?
Hemochrome formation due to oxidative damage–> irreversible -> aggregate
Sulfhydral groups are susceptible to oxidative damage (cats have 8)
How does heinz body formation lead to anemia?
Hemochromes complex with protein band 3 -> clustering of protein band 3 –> creates a recognition site for auto-antibodies
Spherocytosis
Spectin-hemoglobin cross linkage -> increase membrane rigidity and decrease deformabiltiy –> removal by macrophages or lysis
What is methemoglobinemia?
Form of hemoglobin that cannot carry oxygen
-iron is in the ferric state
Caused by oxidative damage
Blood appears what colour when 30% of the hemoglobin is methemoglobin
Brown
-> death at 90%
Copper toxicosis accumulates where? What species is most susceptible?
Accumulates in liver
Sheep
Hypophasphatemia will have what effect on the blood?
Low P -> decreased glycolysis –> hemolysis
What are causes of hypophosphatemia in cats?
Diabetes mellitus
Enteral alimentation
What two bacteria can cause a hemolytic anemia
Clostridium sp
Leptospirosis sp
What is yellow lamb disease?
Hemolytic anemia caused by clostridium perfringins type A
What is the etilogy of Red water disease AKA bacillary hemoglobinuria in cattle?
Clostridum hemolyticum
Associated with fluke migration
Cattle
Anemia Arched back Bloody diarrhea Fever Dyspnea Hemoglobinuria
Clostridum hemolyticum
Red water disease
What can occur in cattle that have free access to water after a period of unavailability
Water intoxication
Decreased osmolailty of plasma leads to hemolysis
What is a virus induced hemolysis of horses
Equine infectious anemia
Aka Swamp fever
What is ‘pink tooth’ in catttle?
Porphyria
Deficiency in uroporphyrinogen III co-synthetase
Can’t make hemoglobin -> accumulate uroporphyrin and coporporhyrin in bone and teeth
Fluorescent pink
Photosensitive
Decreased RBC survival
T/F: porphyria is an autosomal dominant trait in cats resulting in anemia
False
Will not result in anemia in cats
T/F:
Porphyria in pigs does not cause photosensitization
True
