Clin Path 2: Hemorrhage

Question 1

What is acute hemorrhage associated with?

Answer 1

acute blood loss happening for the first time over a short interval such as in cuts and lacerations,

Question 2

Will there be iron deficiency with internal or external hemorrhage?

Answer 2

external hemorrhage

Question 3

What is the difference between internal and external hemorrhage?

Answer 3

Internal hemorrhage occurs when RBCs are retained within the body such as with a ruptured aorta or a blood pool in a body space
External hemorrhage occurs with parasites and GI neoplasms

Question 4

With acute hemorrhage explain the progression from less than 30-60 minutes up until greater than 2-3 days.

Answer 4

Initially, there will be a normal PCV and plasma ratio since with acute blood loss both are lost at the same time and in the same ratio, then after about an hour, there will be fluid redistribution resulting in a lower PCV then after 2-3 days, there will be an increase in PCV due to regeneration and reticulocytosis meaning it is regenerative

Question 5

In chronic external hemorrhage, how will iron stores change over time?

Answer 5

Gradual decrease

Question 6

In chronic external hemorrhage, how will PCV change over time?

Answer 6

PCV will gradually decrease

Question 7

In chronic external hemorrhage, how will MCV change over time?

Answer 7

Initially there will be an increase and then it will gradually decrease

Question 8

In chronic external hemorrhage, how will MCHC change over time?

Answer 8

Gradual decrease

Question 9

In chronic external hemorrhage, how will reticulocyte number change over time?

Answer 9

There will be an increase followed by a decrease/absence

Question 10

No iron = ______ hemoglobin = _________ reticulocytes

Answer 10

no hemoglobin
decrease in reticulocytes

Question 11

In which type of hemorrhage is there compensatory mechanisms? Explain what that means

Answer 11

Chronic hemorrhage
As hematocrit is decreased there is compensation to deal with the decrease in oxygen as red cell mass is decreasing

Question 12

What are examples of internal chronic hemorrhage?

Answer 12

Blood pool in body space due to ruptured aorta

Question 13

What are examples of external chronic hemorrhage?

Answer 13

GI parasites, GI neoplasms

Question 14

Can a chronic external hemorrhage lead to iron deficiency? How would you be able to tell this?

Answer 14

Yes
Need to do a blood smear as it would not be apparent on CBC unless there was a great amount of them

Question 15

What are some components you would observe on a blood smear in the case of chronic external hemorrhage that has progressed into iron deficiency?

Answer 15

Hypochromic cells
Anisocytosis
Poikilocytisis specifically schistocytes
Thrombocytosis

Question 16

What is Poikilocytosis? Schistocytes

Answer 16

Poikilocytosis is variation in shape
Schistocytes are an irregular sickle due to less Hgb making the RBC more fragile

Question 17

What is the last thing that would be seen in an iron deficiency on a blood smear of a chronic external hemorrhage case?

Answer 17

Thrombocytosis

Question 18

Define thrombocytosis. What causes this?

Answer 18

increased number of platelets due to EPO driving bone marrow to release RBC and spleen to contract

Question 19

Define anemia

Answer 19

reduction in RBC, HGB, and PCV (or HCT)

Question 20

What are the associated clinical signs of anemia?

Answer 20

pale mm, weakness, exercise intolerance, lethargy, tachypnea, tachycardia, syncope

Question 21

What are some common ways the body will respond to anemia?

Answer 21

Lowered oxygen tension in arterial blood leading to hypoxia
EPO stimulating erythropoiesis, increased reticulocytes

Question 22

What are the 3 general causes of anemia?

Answer 22

blood loss (hemorrhage)
hemolysis
decreased production of RBC

Question 23

Of the general causes of anemia which are regenerative and which are non-regenerative?

Answer 23

Regenerative = blood loss and hemolysis
Non-regenerative = decreased production of RBC (hypoplasia)

Question 24

What are some common reasons for blood loss or hemorrhage?

Answer 24

blood vessel damage, hemostatic abnormalities (coag factor deficiencies), parasitism, iatrogenic

Question 25

What are some common causes for hemolysis?

Answer 25

RBC destruction, oxidative injury, immune-mediated

Question 26

What are some common causes for decreased production of RBC also known as hypoplasia?

Answer 26

chronic renal failure
selective erythroid hypoplasia
iron deficiency

Question 27

What are the mild, moderate, and marked anemia ranges in dogs and cats?

Answer 27

Mild: dogs > or = 33% // cats > or = 26%
Moderate: dogs > or = 24% // cats > or = 23%
Marked: dogs < or = 23% // cats < or = 23%

Question 28

When plasma proteins such as albumin and globulin are low what does that indicate?

Answer 28

blood loss

Question 29

The regenerative status could be pre-generative, what does this mean?

Answer 29

It could be regenerative but cannot be certain until 2-3 days following the cause of anemia

Question 30

Do young animals have higher or lower PCV?

Answer 30

LOWER

Question 31

What does macrocytic, hypochromic and increased reticulocyte # on cbc results indicate?

Answer 31

regenerative but does not indicate cause

Question 32

What does microcytic, hypochromic cbc results indicate?

Answer 32

iron deficiency

Question 33

What can increased bilirubin indicate?

Answer 33

hemolysis

Question 34

On a blood smear what are RBC morphologies that would support iron deficiency as a result from external chronic hemorrhage?

Answer 34

microcytes, hypochromasia, schistocytes, acanthocytes, asinocytosis