Anemia & Erythrocytosis - Green

Question 1

Which animals have lower than normal PCV?

Higher than normal PCV?

Answer 1

• Lower than normal
  
  • Puppies
  • Kittens
• Higher than normal
  
  • Sight hounds
  • Dachshunds

Question 2

What are 2 big questions you should be sure to ask

the owners of patients that present for anemia?

Answer 2

• Current Medications
  
  • NSAIDs can cause
• Cat → FeLV/FIV status
  
  • Macrocytic, non-regenerative anemia
  • Mild to no reticulocytosis

Question 3

What do petechia, ecchymoses & evidence of deep bleeding suggest?

Answer 3

Platelet or clotting disorder

Question 4

What do icterus, hemoglobinuria & auto agglutination suggest?

Answer 4

IMHA or other causes of hemolysis

Question 5

Can you have a regenerative anemia with a normal MCV or MCHC?

Answer 5

YES

Question 6

How do you calculate the Reticuloctye Index (RI)?

What does it tell you?

Answer 6

• (Patient PCV/45) x Reticulocyte % = RI
• RI > 2.5 = regenerative anemia

Question 7

What does the Absolute Reticulocyte # tell you?

Answer 7

> 60,000 = regenerative anemia

NB: Most in-house CBC machines don’t give you this value

Question 8

When will anemia due to blood loss be regenerative?

Answer 8

after 48-96 hrs

Question 9

List broad causes of Blood Loss.

Answer 9

• Hemoabdomen
• Hemothorax
• Epistaxis
• GI bleeding

Question 10

What type of Hypersensitivity Rxn is IMHA?

What is targeted?

Answer 10

• Type II Hypersensitivity
• Abs against cell surface or cell receptors

Question 11

What does AIHA (Autoimmune Hemolytic Anemia) indicate?

Answer 11

1° IMHA

(“Idiopathic”)

Question 12

What does the term IMHA/IHA imply?

(IHA=immune hemolytic anemia)

Answer 12

May be either 1° or 2°

Question 13

What does “Evan’s Syndrome” refer to?

Answer 13

IMHA + ITP (usually 1°)

Question 14

Which form of IMHA is the most common?

Answer 14

Primary

(induction of self-directed Abs)

Question 15

What classifications of IMHA fall under the “Warm” category?

Answer 15

Class I - III

Question 16

Tell me about Class I IMHA

Answer 16

• Autoagglutination
• IgG mediated
• Extravascular hemolysis (MPS)

Question 17

Tell me about Class II IMHA.

Answer 17

• Involves compliment
• IgM mediated
• Intravascular hemolysis

Question 18

Tell me about Class III IMHA.

Answer 18

• Spherocytes
• IgG mediated
• Extravascular hemolysis

Most common form in dogs

Question 19

Which classifications of IMHA fall under the “Cold” category?

Answer 19

• Class IV
• Class V
• Class IV & V together

Question 20

Tell me about Class IV IHMA.

Answer 20

• Cold agglutination
• Intravascular hemolysis

Question 21

Tell me about Class V IMHA.

Answer 21

• Cold agglutination
• Extravascular hemolysis

Question 22

What is the most common cause of hemolysis in DOGS?

Answer 22

1° IMHA

Question 23

What is the most common cause of hemolysis in CATS?

Answer 23

2° IMHA

Question 24

Which dog breeds have a predilection for IMHA?

Answer 24

• American Cocker Spaniel
• English Springer Spaniel
• Old English Sheepdog
• Irish Setter
• Poodle
• GSD

NB: Any breed can get this!

Question 25

What is the minimum data base for IMHA?

Answer 25

* CBC * Chem panel * RBC parasite evaluation ⇒ blood smear

Question 26

**What are some specific tests used to DX IMHA?**

Answer 26

* Slide agglutination * **Coomb's test** * **ONLY if (-) slide agglutination test** * Tests for possible causes * Rads, tick panel, FeLV/FIV

Question 27

**What values on a UA will point you towards the orgin of hemolysis?**

Answer 27

* *Intra*vascular hemolysis * *Hemoglobinuria* * *Proteinuria* * **Extra**vascular hemolysis * **Bilirubinuria**

Question 28

When is BM assessment needed?

Answer 28

Only with Non-Regenerative Anemias

Question 29

How do corticosteroids help manage IMHA?

Answer 29

* Suppress MPS (mononuclear phagocytic system) activity * Decrease complement & Abs. binding to cells * Suppress Ig production ## Footnote NB: Requires long term therapy, possibly even life long

Question 30

**What drugs can you use for TXing** **Refractory IMHA**? (4)

Answer 30

* Cyclosporine (Atopica®) * Azathioprine (Imuran®) * Leflunomide * Human Immunoglobulin ⇒ but $$$$$

Question 31

What % of IMHA patients require a blood transfer?

Answer 31

70-90%

Question 32

**Which organs are we concerned about in regards to perfusion and resulting DIC?**

Answer 32

* Liver * Pancreas * Gut

Question 33

What is the most common cause of **Non-regenerative anemia** in dogs & cats?

Answer 33

Anemia of Chronic dz.

Question 34

**What is the most common cause of Semiregenerative Anemia**?

Answer 34

**Chronic GI blood loss**

Question 35

Tell me about **Relative polycythemia**.

Answer 35

* High TS * High albumin * Due to: dehydration, fluid loss, diarrhea, burns

Question 36

Tell me about **Absolute polycythemia**.

Answer 36

* Normal TS * True polycythemia ⇒ not due to hemoconcentration

Question 37

Tell me about **1° Absolute Polycythemia.**

Answer 37

* Independent of EPO * Polycythemia Rubra Vera → BM problem

Question 38

Tell me about **2° Absolute Polycythemia**

Answer 38

* EPO dependent * Physiologically appropriate: * 2^nd to chronic hypoxemia * Physiologically inappropriate: * NO systemic hypoxemia

Question 39

How should you approach a patient with **Absolute Polycythemia**?

Answer 39

1. Arterial blood gas & thoracic rads 2. Search for neoplasia/renal dz * Thoracic rads, Abdominal U/S 3. Measure EPO levels

Question 40

What does **Low EPO** indicate?

Answer 40

Polycythemia rubra vera | (1° polycythemia)

Question 41

How do you TX Polycythemia rubra vera?

Answer 41

* Periodic phlebotomy * Hydroxyurea