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Haematology (MOD) > Approach to anaemia 1 > Flashcards

Approach to anaemia 1 Flashcards

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1
Q

What is anaemia defined as?

A

Reduction of either:

  1. PCV or haematocrit
  2. RBC count
  3. Haemoglobin
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2
Q

Is anaemia associated with underlying disease?

A

Always - anaemia is a clinical sign, not a disease

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3
Q

Is acute or chronic anaemia worse?

A

Acute

Chronically anaemic animals can compensate

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4
Q

What are examples of responses to anaemia?

A

Increased RBC 2,3 DPG
Alterations in tissue perfusion
Alterations in behaviour
Different oxygen affinity behaviour (cats only)

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5
Q

What does 2,3 DPG do?

A

Lowers affinity of haemoglobin for oxygen

Facilitates release of oxygen

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6
Q

How does increased RBC 2,3 DPG help in response to anaemia?

A

Increased RBC 2,3 DPG causes lower O2-haemaglobin affinity

Better delivery of oxygen to tissues

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7
Q

What can only cats do in response to anaemia?

A

Different haemoglobins - respond over range of oxygena conditions

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8
Q

Tissue perfusion alters in response to anaemia. What hormonal effect does this have?

A

Lack of perfusion causes increased erythropoietin

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9
Q

Where is erythropoietin produced? What does it do?

A

Kidneys

Stimulates RBC production

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10
Q

Give an example of a behaviour associated with anaemia, particularly in cats

A

Pica

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11
Q

Give examples of what you may see on a physical exam of an anaemic animal

A 
Jaundice 
Pallor
Weakness
Prolonged CRT
Tachycardia etc
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12
Q

How can anaemia be classified (3 descriptions)

A

Degree of severity
Erythrocyte indexes
Regenerative response

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13
Q

What are the 3 degrees of severity for anaemia?

A

Mild, moderate, severe

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14
Q

What are examples of erythrocytes indexes when describing anaemia?

A

Microcytic, normocytic or microcytic

Hypochromic or normochroic

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15
Q

What are the 3 main causes of anaemia?

A

Inadequate production by bone marrow
Increased destruction of RBCs
Haemorrhage

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16
Q

What types of anaemia can be caused by inadequate production by bone marrow - severity, RBC index and regeneration?

A

Mild to severe
Normocytic, normochromic
Non-regenerative

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17
Q

What type of anaemia can be caused by increased destruction of RBCs - regeneration, RBC index and immune mediated?

A

Regenerative
Macrocytic hypo chromic or normocytic normochromic
Immune mediated or non-immune mediated

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18
Q

Does haemorrhage cause proportional or disproportional loss of blood components? Does it cause regenerative or non-regenerative anaemia?

A

Proportional

Regenerative usually

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19
Q

How does the body recover hypovolaemia after haemorrhage?

A

Interstitial fluid moves into vascular space (within a few hours)

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20
Q

A few hours after haemorrhage, how does the total protein differ? What other haematological abnormalities are present?

A

Low total protein - blood diluted by ISF

Decreased PCV, haematocrit and erythrocyte mass

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21
Q

How can acute blood loss present clinically?

A

Hypovolaemic shock - pallor, tachycardia, weak pulse, cold extremities, increased lactate

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22
Q

How long does blood need to be lost to define it as chronic?

A

More than 2 weeks

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23
Q

How long does chronic blood loss need to continue to develop iron deficiency anaemia in an adult?

A

1 month - abundant iron supply

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24
Q

Does acute or chronic blood loss cause IDA?

A

Chronic

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25
Is chronic blood loss regenerative or non-regenerative?
Can be either | Eventually lack of iron slows down erythropoiesis
26
What 2 things on a blood smear indicates regenerative anaemia?
Reticulocytosis | Polychromasia
27
What stain is used for reticulocytes?
Methylene bue
28
Is reticuocytosis or polychromasia more accurate to diagnose regenerative anaemia?
Reticulocytosis | Rely on absolute count not % - do manually as can be mistaken as WBC
29
When do reticulocytes become present from the onset of regenerative anaemia? When are they at peak levels?
Start 2-3 days after onset | Peak at 4-7 days
30
What can cause iron deficiency anaemia?
Chronic haemorrhage Dietary deficiency Congenital haemostatic defects Parasitic infestations
31
What is the most common cause of iron deficiency anaemia? What can cause this?
GI haemorrhage | NSAIDs, ulceration, neoplasia, parasites
32
How does iron deficiency affect red blood cells size and colour?
Causes hypochromic and microcytic RBCs
33
How does iron deficiency cause microcytic and hypo chromic RBCs?
Production of haemoglobin defective with iron deficiency | Extra divisions of RBC precursors cause smaller and hypo chromic RBCs
34
Give examples of drugs that can be used to treat chronic GI haemorrhage
Sucralfate Ranitidine Omeprazole
35
Why should antacids be administered several hours apart from each other?
Interfere with iron absorption
36
How is IDA treated?
Treat underlying cause Iron supplementation (RBC transfusion)
37
What can be given for iron supplementation with IDA?
Oral ferrous sulphate | Intramuscular iron dextran
38
Why should precautions be taken when administering iron dextran IM?
Painful | Can cause anaphylaxis
39
Can IDA be caused by a dietary deficiency?
Yes - if vegan diet Particularly puppies and kittens Supplement and transfer diet
40
What are the 2 causes of immune mediated RBC destruction?
Immune mediated haemolytic anaemia | Neonatal isoerythrolysis
41
Briefly describe the pathogenesis of IMHA?
Production of antibodies against RBCs | RBCs removed by macrophages
42
In which organs does extravascular haemolysis take place?
Spleen Liver Bone marrow
43
Extravascular haemolysis causes the release of what products?
Unconugated bilirubin Aminoacids Globin Iron
44
What affect does extravascular haemolysis have on the spleen and liver?
Enlargement - splenomegaly and hepatomegaly
45
What are the symptoms of extravascular haemolysis?
If liver capacity overwhelmed - hyperbilirubinaemia, bilirbuinurea, jaundice Collapse etc
46
What colour is urine depending on if haemolysis is intra or extravascular?
``` Intravascular = red urine Extravascular = yellow urine ```
47
What are the symptoms of intravascular haemolysis?
Haemoglobinaemia | Haemoglobinuria
48
How can intravascular haemolysis cause renal compromise?
Free haemoglobin damages tubular epithelium
49
What on a blood smear is strongly supportive of IMHA?
Spherocytes | Look smaller but actually just spherical shape
50
How can spherocytes be differentiated from microcytes?
Microcytes have central pallor, spherocytes do not
51
How does IMHA cause spherocytes?
Macrophages pit membrane of RBC | Decreased RBC surface causes loss of shape
52
Is IMHA primary or secondary to infection or neoplasia?
Either
53
Where on a blood smear should you look for spherocytes?
Monocyte layer
54
How can immune mediated haemolytic anaemia be diagnosed by blood smear?
Regenerative anaemia WITH | Marked spherocytosis and or agglutination
55
Why does IMHA cause auto agglutination?
Antierythrocyte antibodies high - causes agglutination | Can be macro (visible grossly) or micro
56
IMHA can lead to cell lysis or cell ghosts - how?
RBC directly damaged by complement
57
Why shouldn't immunosuppressive drugs be given without finding cause of IMHA?
May be due to infection, cause animal to get sicker
58
How can IMHA be diagnosed?
Clinical signs Haematology Coomb's test
59
What is Coombs' test used for? When might it not work?
For autoimmune haemolyticc anaemia - detects anti RBC antibodies Cannot be done if agglutination already present
60
What is the Alvedia anti globulin test used for?
IMHA | Immunochromatography done in house
61
What can cause non-immune mediated increased destruction?
Oxidative damage Intraerthrocytic parasites Mechanical damage - angiopathic anaemia Bacteria/viruses
62
What can cause oxidative damage?
Onion, garlic Red maple (horses) Paracetamol (cats) Copper (sheep)
63
Give 2 examples of intra-erythrocytic parasites
Babes | Mycoplasma haemofelis

Haematology (MOD) (7 decks)

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