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Internal medicine (small) > Approach to anaemia (Yr3) > Flashcards

Approach to anaemia (Yr3) Flashcards

1
Q

what is anaemia?

A

reduction of the RBC mass

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2
Q

what are the three causes of anaemia?

A

inadequate production by bone marrow
increased destruction
loss (haemorrhage)

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3
Q

which of the three overall causes of anaemia would be non-regenerative?

A

inadequate production

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4
Q

which of the three overall causes of anaemia would be regenerative?

A

increased destruction (some exceptions)
haemorrhage/loss (not regenerative enough)

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5
Q

how do red blood cells typically appear when anaemia is being caused by inadequate production from bone marrow?

A

normocytic normochromic

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6
Q

how do the red blood cells typically appear in anaemia from increased destruction?

A

macrocytic hypochromic (lots of reticulocytes)

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7
Q

how do red blood cells usually appear in cases of anaemia caused by haemorrhage?

A

microcytic hypochromic (lack of iron)

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8
Q

what feature of blood is seen in cases of anaemia caused by haemorrhage?

A

hypoproteinaemia (whole blood loss)

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9
Q

how do erythrocyte change in response to anaemia?

A

2,3-DPG increases to lower the haemoglobin affinity for oxygen to improve oxygen delivery to peripheral tissues

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10
Q

what causes the haemic murmur?

A

changes in the blood viscosity due to anaemia

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11
Q

what is the PCV of a mild anaemia in dogs?

A

30-36%

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12
Q

what is the PCV of a moderate anaemia in dogs?

A

18-29%

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13
Q

what is the PCV of a severe anaemia in dogs?

A

<18%

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14
Q

what is the PCV of a mild anaemia in cats?

A

20-24%

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15
Q

what is the PCV of a moderate anaemia in cats?

A

15-19%

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16
Q

what is the PCV of a severe anaemia in cats?

A

<15%

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17
Q

what are the ways erythrocyte index can be described?

A

MCV - mean corpuscular volume
MCHC - mean corpuscular haemoglobin concentration

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18
Q

what are findings on haematology of regenerative anaemia?

A

reticulocytosis
polychromasia

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19
Q

what is reticulocytosis?

A

increased levels of reticulocytes

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20
Q

how can polychromatophils be visualised?

A

staining with diff quik

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21
Q

how can reticulocytes be visualised?

A

stain with new methylene blue

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22
Q

how long does it take for reticulocytes to increase following the onset of anaemia?

A

2-3 days (all anaemias appear non-regenerative initially)

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23
Q

when do reticulocyte levels peak following onset of anaemia?

A

4-7 days

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24
Q

what are the two types of feline reticulocytes?

A

aggregate
punctate

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25
Q

what are the stages of mature red blood cell formation in cats?

A

nucleated red blood cell
aggregate reticulocytes
punctate reticulocytes
mature red blood cells

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26
Q

how long do feline aggregate reticulocytes last for?

A

24 hours

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27
Q

how do patients with hypovolaemic shock present?

A

pallor
tachycardia
weak peripheral pulses
poor peripheral perfusion and cold extremities

28
Q

what causes hypovolaemic shock?

A

acute haemorrhage

29
Q

how is chronic blood loss defined?

A

bleeding for >2 weeks

30
Q

what type of anaemia can be caused by chronic blood loss?

A

iron deficiency anaemia

31
Q

how long to adult patients have to have chronic haemorrhage for to develop iron deficiency anaemia?

A

over a month

32
Q

how is iron deficiency anaemia initially described?

A

regenerative (will then turn non-regenerative as the iron depletes)

33
Q

how do red blood cells appear in cases of iron deficiency anaemia appear?

A

microcytic hypochromic

34
Q

what is the most common cause of iron deficiency anaemia?

A

chronic bleeding (typically GI)

35
Q

what is the usually cause of chronic bleeding resulting in iron deficiency anaemia?

A

GI - NSAIDs, steroids, neoplasia, ulcers

36
Q

what can cause chronic bleeding which may result in iron deficiency anaemia?

A

body system haemorrhage
congenital haemostatic defects
parasitic infestations
(diet is rare but seen in puppies/kittens with vegan diets)

37
Q

how is iron deficiency anaemia treated?

A

determine underlying cause
iron supplementation
blood/packed red cell transfusion

38
Q

what iron supplements are available for iron deficiency anaemia?

A

oral ferrous sulphate
iron dextran (possible anaphylaxis)

39
Q

what are the two categories of haemolysis?

A

immune-mediated
non-immune-mediated

40
Q

what are some non-immune mediated causes of haemolysis?

A

oxidative damage (onions, paracetamol, zinc)
intra-erythrocytic parasites
mechanical damage

41
Q

what is the process of extravascular haemolysis?

A

antibody binds to RBC
macrophage recognises RBC
RBC undergoes phagocytosis
haem converted to bilirubin

42
Q

what happens to the ham released from extravascular haemolysis?

A

converted to bilirubin which is conjugated by the liver and excreted in bile

43
Q

what are the clinical signs of extravascular haemolysis?

A

pallor
lethargy
tachycardia, tachypnoea
splenomegaly
jaundice

44
Q

what happens to free haemoglobin after intravascular haemolysis?

A

excreted in urine (haemoglobinuria)
processed by liver

45
Q

what are the two main categories of haemolysis?

A

intravascular
extravascular

46
Q

what is a consequence of haemoglobinuria?

A

renal compromise from tubular epithelial damage (toxic nephrosis )

47
Q

what are the clinical signs of intravascular haemolysis?

A

sudden onset (severe)
pallor
collapse
jaundice
tachycardia, tachypnoea
splenomegaly
haemoglobinuria

48
Q

what are signs of immune mediadiated haemolytic anaemia on haematology?

A

regenerative anaemia (not always)
autoagglutination
spherocytes
leukocytosis (with left shift)

49
Q

why might patients with immune mediated haemolytic anaemia present with poorly regenerative anaemia?

A

acute onset (pre-regeneration)
immune-targeting of RBC precursors

50
Q

how do spherocytes for?

A

partially phagocytose RBCs lose their cell membrane which leads to the loss of the discoid shape of the cell (spherocyte)

51
Q

what does finding spherocytes on haematology strongly suggest?

A

the animals has IMHA (immune mediated haemolytic anaemia)

52
Q

where should you look for spherocytes on a blood smear?

A

around the monolayer

53
Q

what is autoagglutination?

A

antibody mediated clumping of red blood cells

54
Q

what causes autoagglutination?

A

antierythrocyte IgM

55
Q

what are rouleaux bodies?

A

stacking of RBCs due to increased plasma proteins coating RBCs caused by inflammation (cancer)

56
Q

what animals are rouleaux formations seen as normal?

A

horses and cats

57
Q

how can you test if you are seeing a rouleaux or agglutination?

A

wash anti coagulated blood with saline and the rouleaux will disappear

58
Q

what is the Coombs test used for?

A

detect presence of anti-erythrocyte antibodies and complement on RBCs

59
Q

when can the Coombs test not be used?

A

if agglutination is already present

60
Q

what are the two types of immune-mediated haemolytic anaemia?

A

primary
secondary

61
Q

what can be some possible triggers for secondary IMHA?

A

drugs, vaccines, infectious disease, inflammatory disease, neoplasia

62
Q

what tests could be done if you are suspicious of DIC?

A

PT or d-dimers

63
Q

what changes would be seen on biochemistry of animals with IMHA?

A

elevated ALT and ALP
hyperbilirubinaemia
possible azotaemia

64
Q

what changes would be seen on urinalysis of an animal with IMHA?

A

haemoglobinuria
bilirubinuria
proteinuria

Internal medicine (small) (33 decks)

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