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Y3 MOD clinical pathology > Approach to anaemia 1 > Flashcards

Approach to anaemia 1 Flashcards

1
Q

Define anaemia

A

A deficiency in the number or quality of red blood cells in your body

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2
Q

Anaemia is a value below the reference interval of which tests?

A
  • PCV
  • RBC count
  • Total Hb
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3
Q

Anaemia is associated with which clinical sign?

A

Pallor - mucous membrane colour is paler than normal

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4
Q

Anaemia is always associated with?

A

An underlying disease

- anaemia is a clinical sign, not a disease

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5
Q

What are the 3 causes of anaemia?

A
  • inadequate production of RBCs by the bone marrow (non-regenerative)
  • Increased destruction of RBCs (regenerative)
  • Loss: haemorrhage (not regenerative enough)
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6
Q

How do cells look in non-regenerative anaemia?

A

Normocytic
Normochromic
- cells look normal, just smaller in number

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7
Q

How do cells look in regenerative anaemia?

A

Macrocytic
Hypochromic
(big RBCs that are blue in colour)

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8
Q

How would cells look in anaemia that is not regenerative enough e.g. haemorrhage?

A

Microcytic
Hypochromic
- small pale red cells
Would also see hypoproteinaemia

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9
Q

In response to anaemia, the levels of what substance increase in erythrocytes?

A

2-3 diphosphoglycerate (2-3 DPG)

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10
Q

What is the role of 2-3 diphosphoglycerate (2-3 DPG)?

A

Lowers oxygen haemoglobin affinity which increases oxygen delivery to peripheral tissues

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11
Q

Name the hormone that drives erythropoiesis?

A

Erythropoietin

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12
Q

How do the levels of erythropoietin change in response to anaemia, and what is the effect of this change?

A
  • levels increase

- stimulates bone marrow to increase erythropoiesis

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13
Q

How does behaviour change in response to anaemia?

A

Behaviour changes to reduce oxygen requirements

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14
Q

Give examples of clinical signs of anaemia

A
  • pallor
  • weakness
  • exercise intolerance
  • tachycardia
  • tachypnoea
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15
Q

How would you approach gathering the history of an anaemic animal?

A
  • acute or chronic onset of signs
  • weakness, lethargy
  • evidence of external blood loss
  • access to toxins
  • recent drug therapy
  • is urine normal
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16
Q

What count is required in the full haematology test?

A

Reticulocyte

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17
Q

Which tests would be undertaken in a suspected anaemic animal?

A
  • full haematology
  • total protein, albumin, globulin
  • biochemistry
  • urinalysis
  • diagnostic imaging
  • saline agglutination
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18
Q

What is the purpose of a saline agglutination test?

A

It is used to determine whether red cell agglutinates are present in a blood sample.
When red cell agglutinates are present this indicates that anaemia is due immune-mediated haemolysis.

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19
Q

Which 3 factors classify anaemia?

A
  • degree of severity based on PCT/Hct
  • erythrocyte index
  • regenerative response
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20
Q

PCVs under what value indicate severe anaemia in:

  1. dogs
  2. cats
A
  1. less than 18%

2. less than 15%

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21
Q

Which stain shows erythrocytes?

A

New Methylene blue

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22
Q

What are the hallmarks of regeneration?

A

Reticulocytes = large, blue staining cells

Polychromasia

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23
Q

Define polychromasia

A

Polychromasia is the presentation of multicolored red blood cells in a blood smear test. It’s an indication of red blood cells being released prematurely from bone marrow during formation

24
Q

How many days within the onset of anaemia does it take for reticulocyte numbers to increase?

A

2-3 (anaemia will initially appear non-regenerative)

- numbers peak at 4-7 days

25
Q

What are the 2 main causes of regenerative anaemias?

A
  • haemorrhage

- haemolysis

26
Q

Describe the 2 forms of feline reticulocytes

A

Aggregate - last 24 hours
followed by…
Punctate - last up to 10 days

27
Q

How can you tell apart aggregate and punctate feline reticulocytes?

A

Aggregate stain a lot more purple/blue than punctate

28
Q

Reticulocyte count in cats should be based on the … count

A

Aggregate

29
Q

Hypovolaemic shock occurs as a result of?

A

Acute haemorrhage

30
Q

How does hypovolemic shock present?

A
  • Pallor
  • Tachycardia, Weak peripheral pulses
  • Poor peripheral perfusion, cold extremities
31
Q

How will acute haemorrhage affect PCV:

  • immediately
  • after 24 hours
A
  • initially PCV will be normal as there has been a proportional loss of all blood components
  • after 24 hours PCV will decreased as interstitial fluid moved into circulation
32
Q

Chronic blood loss is defined as bleeding for?

A

more than 2 weeks

33
Q

Chronic blood loss leads to which classification of anaemia?

A

Iron deficiency anaemia due to consumption of iron stores

- takes over one month of blood loss to occur

34
Q

What are the classical changes in red cell morphology in iron deficiency anaemia?

A

Microcytic
Hypochromic
- smaller and paler in colour

35
Q

Describe the process of iron deficiency anaemia resulting in smaller, paler cells

A
  • during erythrocyte formation there needs to be enough Hb to trigger spitting out a nucleus
  • when there is not enough iron to make Hb there is an extra division of precursor cells to try and increase time for Hb accumulation
36
Q

What can cause chronic bleeding of the GI tract?

A

NSAIDs
Steroids
Neoplasia
Ulcers

37
Q

What is a polychromatophil?

A

An immature red blood cell which has already lost its nucleus.
An elevated number of polychromatophils suggests an increased production of erythrocytes by the bone marrow

38
Q

How can iron deficiency anaemia be treated?

A

Iron supplementation - oral ferrous sulphate

39
Q

Increased destruction of RBCs is called?

A

Haemolysis

40
Q

What is immune mediated haemolytic anaemia?

A
  • most common cause of haemolysis

- Production of antibodies against patients red blood cells, which are then removed by macrophages

41
Q

What are some causes of non-immune mediated haemolytic anaemia?

A
  • Oxidative damage: onions, paracetamol in cats, zinc,
  • Intra-erythrocytic parasites
  • Mechanical damage (angiopathic anaemia)
42
Q

Describe extravascular haemolysis

A
  • antibodies bind to RBC
  • macrophages recognise RBC
  • phagocytosis and lysis occurs
43
Q

What arises from partial phagocytosis of red blood cells?

A

Spherocytes

44
Q

Haem in RBCs is converted to … following extravascular haemolysis?

A

Bilirubin

45
Q

What are the consequences of increased bilirubin levels following haemolysis?

A
  • conjugated by the liver and excreted with bile

- if the liver is overwhelmed => hyperbilirubinaemia => jaundice

46
Q

Describe intravascular haemolysis

A
  • intravascular cell lysis
  • extensive complement activation
  • haemoglobinaemia
  • haemoglobinuria
47
Q

What are the consequences of haemoglobinuria following intravascular haemolysis?

A

Renal compromise

- tubular epithelial damage

48
Q

How can immune mediated haemolytic anaemia be diagnosed?

A
  • Clinical signs
  • Typically regenerative, agglutination, spherocytes, leukocytosis with left shift
  • direct antiglobulin test (Coombs test)
49
Q

Describe the appearance of spherocytes

A

Small, round, dense

- no area of central pallor

50
Q

The presence of many spherocytes is indicative of which type of anaemia?

A

Immune mediated haemolytic

51
Q

What do RBC ghosts show?

A

That a cell has been lysed

- not specific for IMHA

52
Q

What is agglutination strongly indicative of?

A

Immune mediated haemolytic anaemia

53
Q

What is rouleaux formation?

A

Stacking of RBCs due to increased plasma proteins coating RBCs

54
Q

What are the causes of rouleaux formation?

A

Inflammation

Cancer

55
Q

In which species is rouleaux formation seen normally?

A

Horses

Cats

56
Q

How can the saline agglutination test be used to differentiate an agglutination from a rouleaux?

A

1 drop of anticoagulated blood + 4 drops of saline

  • Rouleaux will dissapear
  • Agglutination persists
57
Q

Give examples of possible triggers of secondary immune mediated haemolytic anaemia

A
  • drugs
  • infectious disease
  • inflammatory disease
  • neoplasia
  • vaccines

Y3 MOD clinical pathology (10 decks)

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