Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Module 15 > Approach to Anemia in Small Animals > Flashcards

Approach to Anemia in Small Animals Flashcards

1
Q

what is anemia

A

reduction in hemoglobin concentration of the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how are red blood cells produced

A
  1. stem cells are hematopoietic
  2. progenitor cell line: precursor cells to RBCs —> rapidly dividing in the bone marrow
  3. precursor cells: reticulocytes
  4. mature red blood cells

Slow progression and then exponential division

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what cells support the production of red cells

A

Under the influence of EPO from the kidneys under the influence of renal hypoxia

Stromal cells in the bone marrow produce cytokines which support this process

Iron: stored as hemosiderin in macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

describe the breakdowns of the different anemias

A

non-regenerative

“pre-regenerative”

regenerative (hemorrhage, hemolysis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the causes of non-regenerative anemias (7)

A
  1. primary bone marrow disease
  2. iron deficiency anemia
  3. anemia of inflammatory disease
  4. chronic renal failure
  5. endocrine renal failure
  6. endocrine disease (hypothyroidism)
  7. cobalamin deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the causes of regenerative hemolytic anemias (4)

A
  1. IMHA
  2. infectious
  3. oxidative injury
  4. metabolic disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the causes of regenerative hemorrhagic anemias (4)

A
  1. trauma
  2. GI ulceration
  3. hemostatic disorder
  4. ruptured neoplasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are primary bone marrow disease (5)

A
  1. pure red cell aplasia
  2. aplastic anemia
  3. myelofibrosis
  4. bone marrow infiltration
  5. myelodysplastic syndromes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the causes of secondary failure of erythropoiesis (5)

A
  1. anemia of inflammatory disease
  2. chronic renal failure
  3. endocrine disease
  4. hemoglobin synthesis defects: Fe deficiency
  5. nuclear maturation defects: cobalamin deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is pure red cell aplasia

A

anemia affecting the precursors to red blood cells but not to white blood cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is aplastic anemia

A

a bone marrow failure where all cell lines are reduced (infectious disorders such as FeLV or some toxicities)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is myelofibrosis

A

bone marrow failure secondary to replacement of normal marrow elements with fibrous tissue —> crowds it so there’s less space for hematopoiesis to occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is bone marrow infiltration

A

crowding of bone marrow and can cause other cell lines to become affected (lymphomas, etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is myelodysplastic syndromes

A

ineffective hematopoiesis —> non-regenerative anemia or other cytopenias (most common in cats)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is anemia of inflammatory disease

A

inflammatory process that is influencing the bone marrow’s ability to utilize iron. The iron becomes sequestered —> anemias are mild to moderate and are rarely the reason for the animal’s presenting signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how does chronic renal failure cause secondary failure of erythropoiesis

A

ate stage renal failure —> failure of production of EPO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what endocrine diseases can cause secondary failure of erythropoiesis

A

hypothryoidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the distinguishing clinical features of non-regenerative anemia due to primary bone marrow disease (3)

A
  1. clinical signs related to gradual reduction in oxygen carrying capacity –> lethargy/weakness/exercise intolerance
  2. relatively BAR for degree of anemia
  3. other cell lines may be affected: thrombocytopenia/neutropenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the distinguishing features of non regenerative anemia due to secondary failure of erythropoiesis

A

clinical signs relate to primary disease process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the distinguishing features of non regenerative anemia due to secondary failure of erythropoiesis in chronic renal failure

A

PUPD, reduced appetite, weight loss, vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the distinguishing features of non regenerative anemia due to secondary failure of erythropoiesis in hypothyroidism

A

dermatological disease (bilateral symmetrical alopecia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the distinguishing features of non regenerative anemia due to secondary failure of erythropoiesis in Fe deficiency

A

typically associated with chronic low grade external blood loss due to parasitism (internal or external), ulcerative GI disease, chronic urinary loss (often owners don’t notice the chronic blood loss and patients often present because of severe anemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the distinguishing features of non regenerative anemia due to secondary failure of erythropoiesis in cobalamin deficiency

A

typically associated with chronic GI disease, or rarely with genetic defects resulting in inability to absorb vitamin B12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the two categories of hemolytic anemia

A
  1. immune mediated
  2. non immune mediated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are the immune mediated causes of hemolyitc anemia

A

primary (auto immune) IMHA

secondary IMHA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the non immune mediated causes of hemolytic anemia (6)

A
  1. oxidative injury
  2. heinz body anemia
  3. erythrocyte enzymopathies
  4. increased erythrocyte fragility
  5. microangiopathic anemia
  6. hemophagocytic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is immune mediated hemolytic anemia caused by

A

Anemia characterized by the presence of erythrocyte-bound antibody and/or complement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are the two methods of hemolysis in immune mediated anemia (2)

A

1. extra-vascular hemolysis: antibody with RBC becomes opsonized and macrophages phagocytize them —> occurs within the liver and spleen. The macrophages are removing these RBC from the circulation and destroying them

2. intravascular hemolysis: once antibodies are bound to RBC —> compliment fixation and causes a membrane attack on the RBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are the causes of secondary IMHA (3)

A
  1. Infectious: bacterial (leptospirosis, hemoplasmas) or parasitic (babesia, leishmania, ehrlichia)
  2. Drug-induced: sulphonamides, penicillins, vaccines
  3. Neoplasia: lymphoma, leukemias, multiple myeloma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what does feline infectious anemia cause

A

causes hemolysis involving immune mediated and direct erythrocyte damage (plus sequestration)

32
Q

what is the most common reason for hemolytic anemia in cats

A

feline infectious anemia

33
Q

what pathogens cause feline infectious anemia

A

Mycoplasma hemofelis

M. hemominutum (FeLV)

M. turicensis

34
Q

what type of anemia does feline infectious anemia cause

A

Typically regenerative (although concurrent disease may result in non-regenerative anemia)

35
Q

what is seen on blood smears in feline infectious anemia

A

Hemoplasmas seen on blood smears

Ddx Howell-Jolly bodies (little blue dots)

36
Q

how is feline infectious anemia diagnosed

A

PCR

coombs positive (but not always)

37
Q

what does canine babesiosis cause

A

hemolytic anemia including IMHA

38
Q

what are the clinical signs of canine babesiosis (4)

A
  1. pyrexia
  2. thrombocytopenia
  3. +/- splenomegaly, hyperbilirubinemia, hemoglobinuria
  4. +/- AKI, hepatopathy, SIRS, CNS dysfunction
39
Q

what are causes of oxidative injury/heinz body anemia (6)

A
  1. Paracetamol toxicity
  2. Onion toxicity
  3. Benzocaine
  4. Zinc toxicity
  5. Propofol infusion
  6. Diabetes mellitus, hepatic lipidosis in cats
40
Q

what are additional clinical signs you might see associated with hemolytic anemia (5)

A
  1. jaundice
  2. hemoglobinuria (intra vascular)
  3. hepato-splenomegaly
  4. pyrexia
  5. chocolate coloured oral mm as a sign of metHb
41
Q

what are examples of regenerative hemorrhagic anemias

A
  1. trauma
  2. GI ulceration
  3. hemostatic disorders
  4. ruptured neoplasm
42
Q

what are evidence of hemorrhage/blood loss anemias (3)

A
  1. evidence of bleeding: external or internal
  2. signs of hypovolemia
  3. evidence of hemostatic disorder: petechiation/ecchymoses
43
Q

what are signs of external hemorrhage/bleeding

A
  1. melena
  2. hematuria
44
Q

what are the signs of internal bleeding/hemorrhage

A
  1. free abdominal fluid/abdominal distention
  2. signs of intrathoracic hemorrhage (restricted breathing pattern with a pleural effusion)
45
Q

what are laboratory evaluations that can assist in anemia diagnostics (6)

A
  1. PCV
  2. blood smear
  3. reticulocyte assessment
  4. complete blood count
  5. serum biochemistry
  6. ISA, coagulation times, etc
46
Q

what is the approach to the anemia patient

A
47
Q

what questions can the laboratory evaluation explain (6)

A
  1. how severe is the anemia? does it explain the clinical presentation?
  2. is the anemia regenerative or non-regenerative? is the anemia appropriately regenerative?
  3. what do the RBCs look like on blood smear? evidence of IMHA? evidence of oxidative injury? iron deficiency?
  4. could the anemia be secondary to a bleeding disorder? does the patient have enough platelets? evidence of coagulopathy?
  5. are other cell lines affected? could the anemia be due to bone marrow failure?
  6. is there biochemical evidence of an underlying disease?
48
Q

what provides information on how severe the anemia may be

A

PCV

clinical status

49
Q

what PCV % is mild anemia

A

30-39%

50
Q

what PCV % is moderate anemia

A

20-30%

51
Q

what PCV % is severe anemia

A

<20%

52
Q

what are signs of regenerative anemia on blood smear

A
  1. anisocytosis
  2. polychromasia
  3. nucleated RBCs
  4. reticulocytes
53
Q

how is the adequacy of regenerative response assessed (3)

A
  1. absolute reticulocyte count (normal < 60 x 10^9/l in dogs)
  2. corrected reticulocyte count (normal <1%)
  3. reticulocyte production index
54
Q

how do you determine if anemia is non-regenerative with the reticulocyte response

A

if <50% of expected response

the expected response is dependent on the severity of the anemia

pre-regenerative anemia may appear non-regenerative if inadequate time for regenerative response to occur

55
Q

what are spherocytes

A

sphere shaped red blood cells

indicative of hemolytic anemia

56
Q

what is the mean cell volume

A

how large the red cells are

macrocytic

normocytic

microcytic

57
Q

what is the mean corpuscular hemoglobin concnetration

A

levels of Hb in red cell

normochromic

hypochromic

58
Q

what type of laboratory features does primary bone marrow disease show

A

typically normocytic normochromic anemia

concurrent bi-cytopenia or pan-cytopenia

59
Q

what lab features does Fe deficiency anemia show

A

microcytic hypochromic anemia

60
Q

what lab features does chronic renal failure anemia show

A

biochemical evidence of renal failure –> azotemia

61
Q

what lab features does inflammatory anemia show

A

rarely the most significant clinical abnormality –> typically mild to moderate anemia

62
Q

what are the distinguishing lab features of IMHA (6)

A
  1. regenerative anemia
  2. spherocytes
  3. leukocytosis due to a neutrophilia +/- left shift
  4. Evan’s syndrome: concurrent immune mediated thrombocytopenia
  5. hyperbilirubinemia
  6. evidence of organ dysfunction: increased ALT, increased canine pancreatic lipase immunoreactivity
63
Q

what are confirmatory tests for IMHA

A
  1. positive slide agglutination test
  2. positive coombs’ test
64
Q

what are distinguishing lab features of hemorrhage/blood loss anemia (4)

A
  1. regenerative anemia (may be “pre-regenerative” though)
  2. concurrent hypoproteinemia
  3. presence of RBC fragmentation/schistocytes on blood smear
  4. lab evidence of hemostatic disorder: thrombocytopenia, prolongation of coagulation times
65
Q

if a dog has severe (PCV <20%), microcytic, hypochromic anemia which is poorly regenerative what is the likely cause

A

iron deficeincy anemia

66
Q

if a dog has moderate to severe, regenerative anemia with spherocytosis what is the likely cause

A

IMHA

67
Q

how is IMHA diagnosed

A
  1. presence of marked spherocytosis on blood smear
  2. positive in saline slide agglutination test
  3. positive coombs test
68
Q

what are further investigations if you suspect IMHA

A

identify and address underlying cause

  1. thoracic and abdominal imaging
  2. urinalysis including C&S
  3. infectious disease testing?
69
Q

how is IMHA managed

A
  1. immunosuppressive drug therapy
  2. supportive care (transfusion?)
  3. prevention/management of complications
70
Q

what immunosuppressive drugs are used to treat IMHA

A

first line: prednisolone, dexamethasone

second line: azathioprine, ciclosporin, mycophenolate mofetil (MMF), human intravenous immunoglobin

71
Q

what do first line immunosuppressive drugs do

A

block the ability of macrophages to remove antibody coated RBCs from circulation

with prolonged therapy they reduce antibody production

72
Q

what do secondary line immunosuppressive drugs do

A

block the production of antibodies

73
Q

what is the prognosis of IMHA

A

25-70% mortality

74
Q

what is the cause of death in IMHA (4)

A
  1. refractory to trauma
  2. hypoxemia
  3. pulmonary thromboembolism
  4. disseminated intravascular coagulation
75
Q

how is thromboembolic disease prevented

A

thromboprophylaxis: aspirin or clopidogrel

76
Q

how is pulmonary thromboembolism disease managed

A

oxygen

heparin in addition to clopidogrel

Module 15 (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions