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Lymphoreticular > Clinical Approach to Anaemia SA > Flashcards

Clinical Approach to Anaemia SA Flashcards

1
Q

CLinical signs seen with anaemia?

A
  • none/vague if mild or chronic
  • non-specific lethargy, anorexia, collapse
  • specific = pale mms, ^ HR, ^RR, murmur, hyperdynamic pulses
  • severity of signs reflects cause, chronicity and severity of anaemia
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2
Q

What are ddx for pale mms?

A 
> poor perfusion
- probably prolonged CRT
- weak pulses
> anaemia (euvolaemic) 
- normal CRT
- strong pulses (^CO so greater difference betweend iastolic and systolic)
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3
Q

What does ^ HR and RR indicate in an anaemic patient?

A
  • attempting to compoensate

= severe anaemia

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4
Q

How does chronic and acute anaemia present differnetly?

A
  • chronic animal can adapt so cat with chronic anaemia 8% PCV can appear more stable than
  • dog with aute onset PCV 18%
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5
Q

Is signalment ver relevant to anaemia?

A 
YES
> young
- lower PCV normal, pale mm 
- parasites
> older
- neoplastic 
- renal 
> breeds
- cocker IMHA
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6
Q

Important hx points with anaemia?

A
  • lifestyle
  • stable or deteriorating
  • site of bleeding (melana and haematuria, epistaxis)
  • access to drugs or toxins
  • travel hx
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7
Q

PE points important for anaemia?

A
  • stable
  • HR, RR, demarnour
  • icturys
  • pleural and peritoneal space (auscultation and fluid thrill)
  • concurrent disease
  • masses/pain
  • rectal (meleana)
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8
Q

Diagnostic approach to pale mms?

A

> poor perfusion v anaemia
- PCV/TP
- TP v haemorrhage, ^~ haemolysis or non-regenerative anaemia
regenerative v non-regenerative
- time scale
- measure reticulocyte count (correct for PCV or use absolute count better)
* >60,000/ul dog or >40,000/ul cats = regenerative
- blood smear evaluation in house (polychromasia, nRBC)
evidence of underlying cause on smear?
- immune-mediated destruction
- mechanical destruction
- infectious agent

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9
Q

Reasons for regenerative anaemia?

A

> haemorrhage

  • internal (spleen dogs, thorax, trauma, amyloidosis hepatic in cats)
  • external (epistaxis, parasites, meleana, UT)
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10
Q

Why may the spleen be enlarged in anaemia?

A

Help to regenerate RBCs

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11
Q

What might you want to check with haemorhaging patients?

A 
> TP always
\+- 
-coagulation 
- platelet count always
- feacal lungworm (angiostrongylus vasorum)
- ACTH (Addisons s-> GIT Ulceration) 
- search body cavities
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12
Q

Tx blood loss anaemia?

A

> Tx/remove underlying cause

  • remove spleen/gut
  • gastro-protectant if ulcerated but not surgical
  • remove cause of ulceration
  • tx lungworm
  • blood transfusion?
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13
Q

Types of haemolysis

A 
> intravascular 
- complement and IgM mediated
- haemalgobinaemia and haemoglobinuria
> extravascular
-  mcrophages in spleen liver etc. IgG mediated
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14
Q

what signs may help you to differentiate the type of haemolysis

A
  • autoagglutination?
  • Coombs test?
  • Haemaglobinuria
  • Bilirubinuria
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15
Q

4 main cauases of haemolytic anaemia

A 
> IMHA 
- 1* idiopathic
- 2* 
> inherited haemolytic anaemia 
- PK deficinecy
- PFK deficiency 
> Infectious causes
> Misc
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16
Q

Signalment and findings for IMAH

A 
> spaniels
- regenerative anaemia
- no sign of blood loss
- suggestion of haemolysis (jaundice, auto-agglutination (in-saline) spherocyte, ghost cells
- R/O underlying dz 
> babesia, ehrlichia, non-blood cells
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17
Q

Tx IMHA?

A
  • IV fluid tx/blood tranfusion/hboc - oxyglobin not available)
  • immunosupressive tx
  • ? aspirin, clopidogrel
  • ? gastroprotectant
  • nursing (IV catheter, gentle walks)
18
Q

Main immunosuppressives to tx IMHA?

A

> Prednisolone
- suppresses macorphages, complement and Ab binding, suppresses IgG
+ Azathioprine (NOT CATS)
- cyclosporine, mycophenolate, chlorambucil (CATS)

19
Q

Prognosis IMHA?

A

> guarded
- intravascualr worse
- icterus, haemaglobinaemia/uria, poor regeneration, all poor prognostic indicators
common cause of death PTE (thromboembolism)
may relapse
monitor
- regular PCV/TP and haem prior to each dose reduction
- regular biochem drug toxicity

20
Q

What type of IMHA is most common in cats?

A

1* (despite old literature)

21
Q

Why is IMHA in cats more difficult?

A
  • Dx hard

- giving blood products mroe challenging ni cats (often give more volume watch for overload)

22
Q

How does Babesia differ from IMHA?

A
  • looks very similar
  • more sick with babesia
  • more intravasc ?
23
Q

Specieis of babesia. How is this spread controlled?

A
  • B. Canis in europe
  • B. Gibsoni other areas
    > travel scheme
24
Q

Which species does mycoplasma affect?

A
  • cats mainly

- dogs too after splenectomy

25
Q

Which infections can act as an immunological trigger for IMHA?

A
  • Any theoretically -> 2* IMHA
26
Q

Miscellaneous causes of haemolysis

A 
> oxidative damage
- paracetamol (cats) 
- onions, garlic, Zn, Cu 
> hypophosphataemia (DKA) 
> shear injury (microangiopathic) d/t damaged endothelium
27
Q

How do non-regenerative anaemia patients present?

A
  • mild/severe
  • may be o nvious on PE or not
  • variable!!
    > reticulocytes
    -
28
Q

Most common cause fo non-regenerative anaemia?

A
  • anaemia of chronic inflammation
    Mild - moderate anaemia (dogs 25-36%, cats 18-26%)
  • chronic infections and non-infectious disorders
  • d/t poor iron storage/utilisation and shortened red cell survival, imparied erythrocyte production
29
Q

k

A

-

30
Q

What type of anaemia does renal dz cause?

A
  • normocytic, normochromic

> not always obviuos on PE

31
Q

Pathogenesis of renal dz anaemia?

A
  • inadequate EPO production
  • decreased erythrocyte lifespan
  • decreased marrow response to EPO
  • other factors (haemorrhage caused by uraemic ulcers etc.)
32
Q

What should always be tested for in anaemic cats?

A
  • FeLV
33
Q

What type of anaemia does FeLV cause?

A
  • macrocytic normochromic or normocytic normochromix in chronic dz
  • may induce IMHA/1* BM dz
  • > 75% anaemic cats found to be FeLV+ in past studies
34
Q

3 main miscellaneous non-regenerative anaemia

A 
> nutrient
- iron deficieny
- copper def (Cu associated hepatitis in labs)
- folate/cobalamin deficiency (neutropenia, severe non-regen anaemia,s tunted growth, inherited dz in some breeds)
> endocrine
- hypothyroid
- hypoadrenocorticism 
- hyperestrogen 
- mild-mod anaemia, severe pancytopenia poss with hyperestrogenism
> liver
- young dogs with PSS 
- mild-mod 
- iron metabolism affected
35
Q

Types of BM dz? What type of anaemia would this cause?

A

> non-regenerative

  • pure reed cell aplasia
  • aplastic anaemia (pancytopenic)
  • neoplaisa (myelophthisis)
  • myelodysplasia (abnormal development RBC)
  • myelofibrosis (fibrosis replaces BM)
36
Q

Approach to non-regenerative anamiea

A
  • depends on severity
  • similar investigation path to regenerative anaeia but Ddx different (look for dz)
  • if severe and no cause found on screening tests - BM
  • Bi-pancytopenia - BM
37
Q

Where are BM samples taken?

A
  • humerus or iliac crest
38
Q

Outline BM sampling technique

A
  • sedation + local/GA
  • clip and prepare aseptically
  • aspirate (once obtained smear quickly as clots in seconds)
  • core-roll preparations then into formalin
39
Q

Tx BM dz -> non-regenerative anaemia?

A
  • pure red cell aplasia (= IMHA Tx)
  • aplastic anaemia (?)
  • neoplasia (myelpthisis)
  • myelodysplasia (NO tx)
  • myelofibrosis (revesible, tx underlying dz)
40
Q

What is anaemia?

A
  • NOT a clinical sign/dx
    = v PCV, HCT, Hb, RBC
    may or may not be obvious on PE

Lymphoreticular (31 decks)

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