Approach to Anemic Patient Flashcards

1
Q

What is anemia?

A

-reduced oxygen carrying capacity from insufficient hemoglobin and red blood cell mass within the vasculature
-should probably be called hyponemia as it does not mean “no blood”
-not a diagnosis, this is a PROBLEM

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2
Q

What are the 3 broad differentials for anemia?

A

Loss
Destruction
Lack of Production

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3
Q

What are the two types of loss that occurs that can cause anemia?

A

Induced due to trauma or parasites

Spontaneous due to thrombocytopenia, coagulopathy or DIC

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4
Q

What are some causes of RBC destruction?

A

-infectious
-immune mediated (most common)
-drug induced
-mechanical (DIC)

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5
Q

What are the different problems that can result in lack of production of RBCs?

A

Refractory:
-anemia of chronic disease or renal failure (lack of erythropoietin)
-these can potentially be reversed or addressed

Bone marrow:
-aplastic anemia, pancytopenia, drugs, immune mediated, neoplastic, idiopathic
-often untreatable

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6
Q

How long do WBCs last in the bloodstream? Platelets? RBCs?

A

WBC: 7 hours
Platelets: 7 days
RBCs: 7 weeks

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7
Q

What are history findings that may indicate a patient could be anemic?

A

-Weakness/lethargy/collapse
-pallor/pale gums
-jaundice/icterus/yellow gums/sclera/skin
-recent trauma (especially blunt)
-melena or hematochezia
-obvious blood loss
-breathing changes: due to tissue hypoxia, hemothorax, or pulmonary contusions
-distended abdomen (could be hemoabdomen)

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8
Q

What are some common physical exam changes seen with anemia?

A

-pale pink to white mucous membranes
-tachycardia
-heart murmurs (due to changes in blood viscosity)
-bounding or weak pulses
-dullness, weakness, collapse
-icterus
-bruising/ecchymoses/petechiae
-pleural or abdominal effusion
-obvious bleeding

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9
Q

Explain how the clinical signs of anemia can differ based on chronicity

A

In more chronic cases of anemia, the animals have the opportunity to adapt
-in acute cases, clinical signs are more likely to be more severe

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10
Q

How do you confirm that a patient is anemic?

A

-measure PCV AND total solids (need both in order to characterize the anemia and reach definitive diagnosis)
-CBC- hematocrit, blood smear, reticulocyte count

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11
Q

T/F: you can confirm rapid blood loss with bloodwork

A

False
-Hct and PCV measure the percentage of RBCs in the blood -wont change with loss
-CBC cannot tell you how much total blood is in the patient
you can be anemic with a normal PCV

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12
Q

What is the difference between Hct and PCV?

A

They are essentially the same, except the Hct is calculated compared to PCV which is directly measured

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13
Q

After acute blood loss, when and why do the PCV drop?

A

PCV drops within a few hours
-number of red cells does not change but water enters vasculature through pulling from interstitium and intercellular cases

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14
Q

Should you give fluids to anemic patients?

A

Yes- should not be worried that fluids will worsen the anemia
- you are just revealing the anemia that was already there

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15
Q

What changes occur to the PCV/TS with anemia due to loss? Destruction? Lack of production?

A

Loss: PCV and TS will both drop

Destruction: PCV will go down, TS will stay the same or increase (due to dehydration or due to inflammatory reactions). Serum may be yellow

Lack of Production: Decreased PCV and normal total solids

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16
Q

What changes may you see on a CBC with lack of production?

A

Non-regenerative anemia (lack of reticulocytes, normal MCV and decreased MCHC)
-Normocytic, hypochromic

17
Q

What occurs to the MCV and MCHC with regenerative anemia?

A

Increased MCV- When the cells are immature, as in the case of regeneration they are larger

Decreased MCHC- hemoglobin concentration is lower as the cells are larger

AKA Macrocytic, hypochromic or polychromasia

18
Q

What changes may you see on a CBC with loss?

A

Regeneration - increased reticulocytes (macrocytic, hypochromic)
-but this takes some time (2-3 days)
-with acute loss, don’t expect to see regeneration right away

19
Q

What changes may you see on a CBC with destruction?

A

Regeneration- increased reticulocytes (macrocytic, hypochromic)
-increased spherocytes if IMHA
-inflammatory leukogram

20
Q

What types of blood loss can be either acute or chronic?

21
Q

If you suspect blood loss but you cant find blood anywhere, what is the most likely place the blood is going?

A

Being lost in the GI tract

22
Q

Describe hemolytic anemia

A

Commonly this is immune mediated
-sometimes can be due to infections, oxidative damage or toxins
-rarely can be caused by microangiopathies, or inherited RBC abnormalities
-hemolysis can be intravascular or extravascular or both

23
Q

How do you expect the plasma to look different when there is intravascular hemolysis vs extravascular?

A

Extravascular- plasma will appear icteric
Intravascular- plasma may appear redder than normal due to release of hemoglobin

24
Q

Describe the main causes of hypoplastic anemia

A

Refractory: anemia of chronic disease/anemia of chronic inflammation, renal failure, iron deficiency
-can diagnose through bloodwork

Bone marrow diseases: aplastic anemia, pancytopenia, drug induced, cancer, immune mediated, idiopathic, infectious
-definitive diagnosis from bone marrow sampling (aspirate or biopsy)

25
What is a condition that can look a lot like IMHA but does not often result in spherocytes?
Zinc toxicosis -most commonly from ingestion of pennies made after 1982 -results in vomiting, moderate to severe regenerative anemia, hyperbilirubinemia, inflammatory leukogram -treat through foreign body surgery in most cases or endoscopy
26
What confirmatory test can you run to support diagnosis of IMHA?
Slide agglutination test -perform with anticoagulated blood -combine one drop of blood and one drop of saline and look for agglutination - supportive of diagnosis
27
What are some secondary causes of IMHA?
Babesia in dogs, FeLV in cats, mycoplasma in cats -cancer: screen via radiographs, abdominal imaging
28
What is the mainstay of treatment for IMHA?
Prednisone for immunosuppression - 2 mg/kg/day split into BID dosing. Usually see response in 5-7 days - can also add on adjunctive agents such as azothiaprine in order to reduce the side effects of prednisone Antithrombosis: -antiplatelet drugs: clopidogrel, aspirin -anticoagulant drugs: more effective than antiplatelet drugs but more expensive. Includes unfractionated heparin, low molecular weight heparin, oral anti-xa (rivoroxaban) Blood transfusion as needed
29
What are the 2 reasons that patients die from IMHA?
-thromboembolism -or not enough money for blood transfusions
30
When should blood transfusions be performed in anemic patients?
When the patients have severe clinical signs of disease
31
In a patient with rodenticide poisoning, what should you give the patient in terms of fluids?
Fresh frozen plasma -clotting factors are what these patients need due to the current ones in their system not working -LRS would be another decent option for rehydration, as well as whole blood or packed red cells (in addition to plasma) **Start with fluid bolus, then give fresh frozen plasma after thawed, then if there is still minimal to no improvement add on packed red cells**
32
When should you give the vitamin K in rodenticide cases?
As soon as possible after stabilization with fluids/plasma -if known exposure but no evidence of bleeding, can just give the vitamin K
33
What is the main cause of a microcytic, hypochromic anemia?
Iron deficiency anemia -due to chronic external blood loss (usually lost to GI tract or due to parasitism)