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Year 3 MOD > Clinical Pathology: Equine Clinical Pathology and Anaemia > Flashcards

Clinical Pathology: Equine Clinical Pathology and Anaemia Flashcards

1
Q

What must be considered about clinicopathological tests available in horses?

A

Accuracy, Precision

Sensitivity and Specificity

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2
Q

What is sensitivity and specificity?

A

Sensitivity- % of disease positive animals that correctly identified as positive

Specificity- % of disease negative animals that correctly identified as negative

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3
Q

What is PPV and NPV?

A

PPV- % of positive results that are actually positive

NPV- % of negative results that are actually negative

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4
Q

What can be used for diagnosis of laminitis risk in ponies?

A

Adiponectin concentration- hormone from fat

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5
Q

What is haematology, histology, cytology, urinalysis, coprology and serology?

A

Haematology- morphology of the blood and blood forming tissues

Histology- microscopic structure composition and function of tissues

Cytology- cells their origin, structure, function and pathology

Urinalysis- urine test

Coprology- shit

Serology- study of serum

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6
Q

What is the difference between serum and plasma?

A

Serum is allowing a clot and then taking centrifuged fluid- plasma with coagulation proteins removed

Plasma is mixing with anticoagulant then centrifuging

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7
Q

How does breed affect PCV, red blood cell count and haemaglobin?

A

Hot blooded horse has a higher PCV, RBCC, and haemoglobin

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8
Q

What blood proteins are there?

How is it measured?

What can affect the results?

A

Blood proteins- albumin, globulin, fibrinogen

Measured as total protein on refractometer

Icterus, lipaemia, haemolysis affect results

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9
Q

What does albumin do?

A

Controls colloid oncotic pressure

Binds cations and hormones

Binds to drugs

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10
Q

What different proteins show on serum protein electrophoresis?

A

Albumin

Y globulins- immunoglobulins

A- globulins- acute phase protein, a-lipoproteins, antithrombin III

B-globulins- complement, transferrin, plasminogen

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11
Q

What is hyperproteinaemia and what is a common cause?

A

Increases total protein- albumin, globulin or both

Dehydration

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12
Q

What is hyperglobulinaemia and what is the most common causes?

A

Increased globulins

Most common causes are chronic inflammation or tumour of B lymphocytes

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13
Q

What is panhypoproteinaemia?

A

Aggressive intravenous therapy causing severe protein loss

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14
Q

What can cause hypoalbuminaemia?

A

Albumin is a small molecule therefore

More loss across intestinal mucosa/glomerulus

Loss of effusion

Decreased production

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15
Q

What does hypoproteinaemia often cause in horses?

A

Pitting ventral oedema

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16
Q

What can cause oedema?

A

Increased hydrostatic pressure

Decreased oncotic pressure

Increased permeability

Impaired lymphatic drainage

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17
Q

What is a myopathy?

A

A disease of the muscle

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18
Q

What are the clinical signs of liver disease in horses?

A

Varied and non-specific

Weight loss
Colic
Anorexia
Photosensitisation
Neurological signs
Diarrhoea
Jaundice

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19
Q

What enzymes would be released from damage to the liver?

A

GGT

GLDH

AST

ALP

LDH

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20
Q

What is anaemia?

What three mechanisms can produce anaemia?

A

Anaemia is a reduction in circulating red blood cell volume or haemaglobin concentration

Blood loss

Increased RBC destruction

Decreased RBC production

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21
Q

Why should horses PCV not be assessed after or during excercise?

A

The spleen in horses is a reservoir for erythrocytes- PCV can increase by 0.25L/L

Also a platelet reservoir- 1/3 of platelets

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22
Q

What are the clinical signs of anaemia in horses?

A

Lack of oxygenation

Tachypneoa, tachycardia

Pallor

Excercise intollerance, lethargy, weakness- collapse

Underlying disease process

Fever, ictus, pigmenturia

23
Q

What is hypovolaemic shock and what are its clinical signs?

When do clinical signs show?

A

A form of shock caused by severe hypovolaemia

Tachycardia

Tachypnoea

Hypothermia

Pale and dry mucous membranes

Prolonged CRT

Weak pulse

Cold extremities

Muscle weakness

Clinical signs of shock become apparent after 30% of blood loss

24
Q
A
25
Q

How is anaemia diagnosed in horses?

A

PCV-

Normal throroughbreds- 35-45%, Ponies and draught breeds 26-35%

History and clinical exam
External/internal blood loss
Evidence of clotting disorder
Evidence of haemolysis

Initial labs- complete blood count, total plasma protein, plasma fibrinogen, lactate, RBC morphology

26
Q

What compensatory mechanisms for anaemia do horses have?

A

Spleen can mask the extent of blood loss for several hours post haemorrhage

Catecholamines induce vasoconstriction and increase cardiac output

Plamsa volume is expanded by withdrawl of fluid from the interstitium and increased reabsorption of water in the renal tubules via ADH

Fluid movement into the vascular system continues

Decline in the TPP

Decrease in PCV not seen till 12-24 hours post haemorrhage

27
Q

Why is it difficult to diagnose regenerative vs non-regeneratvie anaemia in horses?

A

Peripheral signs of regeneration such as reticulocytosis and polychromasia rarely occur

Bone marrow evaluation may be required to confirm non-regeneratvie myeloid disorders

28
Q

How can regenerative anaemia be diagnosed in horses?

A

Regenerative anaemia without anthing else casues hypoproteinaemia

Diagnostic evaluation of suspected haemolytic anaemia should inclue thorough blood smear, urinalysis, coombs and coggins test

29
Q

What might be seen in a horse with haemolysis in its smear?

A

Spherocytes, heinz bodies, saline agglutination, erythrocye osmotic fragility and coombs test

30
Q

What are the differential diagnoses for horses with anaemia?

A

Acute blood loss anaemia

Coagulopathies

Chronic blood loss anaemia

Haemolytic anaemia

Blood parasites

EIA

Oxidant induced haemolytic anaemia

Non-regen anaemia

31
Q

What can cause acute blood loss anaemia?

A

Haemorrhage due to traumatic or surgical wounds

Guttural pouch mycosis

Uterine artery rupture

Mesenteric artery rupture- rare

Epitaxis- nose bleed- rare

Tumours- splenic disease, haemangiosarcoma

Thoracic large vessel rupture in race horses

Renal haemorrhage

Rib fracture- especially foals

32
Q

What can cause coagulopathies in horses?

A

Rare- usually DIC consumptive coagulopathy secondary to sepsis, severe systemic inflammation vs inherited

Secondary to liver disease

33
Q

How does chronic blood loss anaemia develop and what can cause it?

A

Allow the bone marrow to regenerate erythrocytes as they are lost, therefore anaemia only develops once the rate of erythropoiesis is exceeded by the rate of haemorrhage

Gradual tissue hypoxia allows physiological adaptation so clinical signs of anaemia masked until PCV drops <0.15l/l

Usually GIT bleeding- parasitic, neoplasia, gastric/duodenal ulceration, NSAID toxicosis, may be urogenital

34
Q

What can cause haemolytic anaemia?

A

True immune mediated haemolytic anaemia rare

More likely secondary haemolytic:

Penacillin reaction

Clostridium perfringens

Injection site abscess

Lymphoma

35
Q

What is EIA?

What blood parasites can cause anaemia?

A

Equine infectious anaemia- ehrlichiosis

Babesia divergens cause anaemia

36
Q

What can cause non-regenerative anaemia in horses?

A

Bone marrow disorders

Anaemia of chronic disease

Iron deficiency- uncommon

Folic acid deficiency

37
Q

How is acute blood loss diagnosed?

What are the treatment aims?

A

Based on history of recent haemorrhage, clinical signs and eventual development of anaemia accompanies by hypoproteinaemia

Identification and elimination of the cause, provision of nursing cate, ensuring adequate tissue perfusion, minimising stress

38
Q

How can acute blood loss be diagnosed?

A

Blood transfusion is inadequate to support life

Stop bleeding- ligation, haemostats, pressure bandage

Unable to stop bleeding- permissive hypotension, maintain enough blood pressure to deliver O2 to heart/brain

Once bleeding stopped- replace circulating volume- hypertonic saline, crystalloids, colloids

Adjunctive therapy- iron, vit B12, anabolic steroids, corticosteroids, Vit C or antioxidants

Blood transfusion when >30% blood volume lost, clinical signs of hypovolaemic shock

39
Q

What is anaemia?

What are the three physiological mechanisms of anaemia?

A

A reduction in circulating red blood cell volume or haemoglobin concentration

Functionally defined as decreased oxygen-carrying capacity of the blood
occurs when the PCV is reduced below that which is considered normal for the horses are, breed and use

Mechanisms

Blood loss

Increased destruction

Decreased production

40
Q
A
41
Q

Why does the spleen need to be taken into consideration for horses anaemia?

A

Reservoir for erythrocytes- PCV can increase by 0.25L/L

Also a platelet reservoir (1/3)

Therefore don’t assess Horses during or after exercise

42
Q

Why do clinical signs of anaemia vary and what are the clinical signs?

A

Depends on how rapidly it develops
CS:

  • Lack of oxygenation, tachypnoea, tachycardia
  • Pallor
  • Excercise intolerance, lethargy, weakness- collapse
  • Underlying disease process- haemorrhage, pyrexia, anorexia, weight loss
  • Fever, icterus, pigmenturia may accompany haemolysis
  • Epistaxis, haematuria or melaena may signal chronic blood loss
43
Q

What are the clinical signs of hypovolaemic shock?

A
  • Tachcardia
  • Tachypnoea
  • Hypothermia
  • Pale and dry mucous membranes
  • Prolonged CRT
  • Weak pulse
  • Cold extremities
  • Muscle weakness
  • Clinical signs become apparent after 30% of blood loss- 500kg = 13L
44
Q

What is the normal PCV in TB, Ponies and Draught breeds?

How is anaemia diagnosis approached?

A

Normal PCV- TB 35-45%, Ponies and Draughts (26-35%)

  • History and clinical exam
  • Acute or chronic
  • External/internal blood loss
  • Evidence of a clotting disorder
  • Evidence of haemolysis
  • Initial labs- complete blood count, total plasma protein, plasma fibrinogen, lactate
  • RBC morphology
45
Q

What are the compensatory mechanisms for anaemia in horses?

A
  • Spleen- masks the extent of blood loss for several hours post haemorrhage
  • Catecholamines induce vasoconstriction and increase cardiac output
  • Plasma volume is expanded by the withdrawal of fluid from the interstitium and increased reabsorption of water in the renal tubules and GI by ADH
  • Fluid movement into the vascular system continues
  • decline in the TPP
  • Decrease in PCV not seen until 12-24 hr post haemorrhage
46
Q

How is regenerative or non-regenerative anaemia distinguished?

A

Peripheral signs of regeneration such as reticulocytosis and polychromasia rarely occur in horses
Howell-Jolly bodies are occasionally found in eryhrocytes
Bone marrow evaluation may be required to confirm non-regen myeloid disorders

Diagnosis- rule in or out haemolysis

  • Pink plasma if intravasculae
  • Regenerative anaemia without concomitant hypoproteinaemia
  • Diagnostic evaluation of suspected haemolytic anaemia- should include a thorough blood smear, urinalysis, coombs, Coggin
  • Smear- spherocytes, Heinz bodies
  • May see an increase in free HB, MCH, MCHC
47
Q
A
48
Q

What are the most likely differentials for clinical presentations of anaemia?

A

Acute blood loss anaemia

Coagulopathies

Chronic blood loss anaemia

Haemolytic anaemia

Blood parasites

Oxidant induced haemolytic anaemia

Non-regen anaemia:
bone marrow disorders, anaemia of chronic disease, iron deficiency, folic acid deficiency

49
Q

What can cause acute blood loss anaemia in horses?

A
  • Haemorrhage due to trauma or surgical wounds
  • Guttural pouch mysosis
  • Uterine artery rupture
  • Mesenteric artery rupture- rare
  • Epistaxis rare
  • Tumours- splenic disease, haemangiosarcoma
  • Thoracic large vessel rupture in race horses
  • Renal haemorrhage
  • Rib fracture
50
Q

What can cause coagulopathies in horses?

A

Rare-

usually DIC secondary to sepsis or severe systemic inflamation

or

Secondary to liver disease

51
Q

How is chronic blood loss different to acute?

What can cause chronic blood loss anaemia in horses?

What causes haemolytic anaemia?

A

Chronic- allows the bone marrow to regenerate, anaemia only develops once erythropoiesis is exceeded by the rate of loss

Chronic anaemia causes-
Usually GIT- parasitic, neoplasia, gastric/duodenal ulceration, NSAID toxicosis
Maybe urogenital blood loss

Haemolytic anaemia-
True immune-mediated haemolytic anaemia is rare, more likely secondary (penicillin, C. perfringens, injection site abscess, lymphoma)
Neonatal isoerythrolysis- immune-mediated anaemia

52
Q

What are the aims of treating anaemia?

How is it treated?

A

Aims-
Identification, elimination of the cause, and provision of nursing care, ensuring adequate tissue perfusion, minimising stress

Treatments-

  1. Stop bleeding- ligation, haemostats, pressure bandage
  2. Unable to stop- permissive hypotension, maintain BP for brain/heart, do not dilute RBCs and increase haemorrhage
  3. Stopped bleeding- replace circulating volume- hypertonic saline, crystalloids, colloids, blood transfuction

Adjunct therapy- Iron, Vit B12, Anabolic steroid, Corticosteroids, Vit C or antioxidants

Blood transfusion- when >30% blood volume loss, increased latate PCV<15%

53
Q

How is the amount of blood volume needed worked out for transfusion?

A

Blood volume = 80ml/kg

Blood deficit = (normal PCV - animal PCV) x (0.08 x weight)

Year 3 MOD (42 decks)

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