Defense & Barriers 2: Anemia & Thrombocytopenia Flashcards
anemia…
= definition? & what 3 parameters define it?
ALWAYS associated with….
is anemia a clinical sign?
= occurs when there’s a REDUCTION IN RBC MASS detected by the following values…
1. PCV/HCT
2. RBC count
3. Total Hb
ALWAYS associated with UNDERLYING DZ
Anemia IS NOT A CLINICAL SIGN unless it’s IMHA
how does anemia cause INCREASED EPO?
when KIDNEYS HAVE LESS PERFUSION = HIGHER PRODUCTION OF EPO
when anemia is ACUTE, clinical signs are….
clinical signs are WORSE because BODY HASN’T HAD TIME TO ADAPT TO LOWER HCT
in CHRONIC anemia, body is BETTER ABLE TO ADAPT TO LOWER HCT, better CLINICAL SIGNS/BEHAVIOR
5 common clinical signs for ANEMIA
- Pallor (pale mucous membranes) –> NOT ALWAYS PRESENT
- Weakness
- Exercise intolerance
- Tachycardia/tachypnea
- “Hemic” heart murmur –> TURBLUENT blood moving through valves
APPROACH to solving anemia…
always start with WHAT? & give examples of 3 good questions to ask
what 2 diagnostic tests should ALWAYS be done for anemia?
3 additional diagnostic tests?
3 reasons why we do IMAGING?
ALWAYS START WITH HISTORY & PE
1. CHRONIC or ACUTE onset of signs?
2. any CONCURRENT DISEASES?
3. breed/age of pet?
2 diagnostic tests ALWAYS done?
= FULL CBC and TOTAL PROTEIN!
3 additional?
1. CHEMISTRY
2. URINALYSIS
3. IMAGING
3 REASONS to do imaging?
1. Evidence of bleeding
2. Splenomegaly
3. Concurrent diseases
DECREASED production… (3)
1. what type of anemia?
2. pathophys?
3. what classification of anemia?
- NON-regenerative anemia
- Due to BONE MARROW NOT MAKING ENOUGH RBCs
- Often MILD –> SEVERE anemia
CLASSIFICATIONS of anemia (3, in dogs and cats for FIRST ONE & WHAT PARAMETERS EACH CLASSIFICATION IS BASED ON)
- SEVERITY (based on PCV/HCT)
–> MILD = 30-36% in dogs, 20-24% in cats
–> MODERATE = 18-29% in dogs, 15-19% in cats
–> SEVERE = <18% in dogs, <15% in cats - ERYTHROCYTE INDEXES (MCV/MCHC)
–> HYPERCHROMIC ISN’T POSSIBLE, could be from hemolysis RELEASING Hb INTO BLOOD - REGENERATIVE RESPONSE (polychromasia/reticulocyte count)
how can something be PRE-regenerative?
could be due to WAITING for RBCs to come back! takes 3-5 days for regeneration
in DESTRUCTION, RBCs are… (MCV/MCHC)
MACROCYTIC & HYPOCHROMIC
increase in RBCs in response to anemia starts at ____-____ days and PEAKS at ____-____ days
2-3, 4-7
when trying to determine if an anemia is REGENERATIVE, _____ is more SENSITIVE/ACCURATE than ____
RETICULOCYTOSIS, POLYCHROMASIA
ID top & bottom arrows!
** what species is this?
which one do we want to see MORE of in REGENERATIVE anemia & why?
in FELINES, RETICULOCYTES can be 2 types!
TOP = AGGREGATE
BOTTOM = PUNCTATE
want to see more AGGREGATE because PUNCTATE can live in circulation up to 10 days, so NOT ACCURATE REPRESENTATION OF REGENERATION
= DEFINITION of BLOOD LOSS (+ 3)
how is blood volume recovered? (2)
can cause the pet to present with ____, especially if blood loss is ____ (+ 5 clinical signs)
= PROPORTIONAL loss of ALL BLOOD COMPONENTS, including…
1. RBCs
2. WBCs
3. Plasma
how is volume recovered?
1. interstitial fluid should MOVE INTO VASCULAR SPACE WITHIN A FEW HOURS
2. This causes DILUTION of the blood and TOTAL PROTEIN WILL DECREASE
present with HYPOVOLEMIA, especially if loss is ACUTE…
1. Pallor
2. Weak peripheral pulses
3. Prolonged CRT
4. Cold extremities
5. Tachycardia/tachypnea
what disease is this?
IRON-DEFICIENCY ANEMIA
** MICROCYTIC, HYPOCHROMIC
CHRONIC blood loss…
= definition
what’s a common target/why?
can lead to WHAT disease?
= when bleeding has been occurring MORE THAN 2 WEEKS
common target?
–> GI is a COMMON TARGET!
–> Bleeding slowly a little bit every day
what disease?
–> Can lead to CONSUMPTION OF IRON STORES = iron deficiency anemia
IRON DEFICIENCY ANEMIA…
HOW LONG does it take to present in adults?
what kind of classification of anemia is this?
presentation? (3)
caused mainly by WHAT? (+ 4 inciting causes)
what is a LESS COMMON cause of it? (+3 regions where this can occur)
how long?
–> iron stores are abundant in adults, so takes >1 MONTH of CONTINUED BLEEDING for iron deficiency anemia to occur
classification?
–> ONCE WE LOSE IRON = NON-REGENERATIVE ANEMIA
presentation?
1. MICROCYTIC = small bc NOT ENOUGH Hb PRESENT TO STOP DIVISION
2. HYPOCHROMIC = LOSS OF FE CAUSES DECREASED Hb PRODUCTION
3. On blood smear, see CENTRAL PALLOR in erythrocytes
caused mainly by GI BLEEDS, which can be caused by…
1. NSAIDs
2. Steroids
3. Neoplasia
4. Ulcers
LESS COMMONLY = HEMORRHAGE from another organ system..
1. Urinary tract
2. Skin
3. Respiratory system
CONGENITAL HEMOSTATIC DEFECTS and PARASITIC INFECTIONS can cause…
IRON DEFICIENCY ANEMIA
PUPPIES on VEGAN DIETS are prone to developing…
IRON DEFICIENCY ANEMIA
TREATMENT options for IRON DEFICIENCY ANEMIA? (4)
- FIRST DETERMINE THE UNDERLYING CAUSE = treat parasitism, use gastroprotectants for ulcers, Sx for neoplasia…
- Iron SUPPLEMENTATION
–> Can administer ORAL FERRUS SULPHATE
–> 5 mg/kg dog, 50 mg/kg cat - IM Iron dextran?
–> Can cause anaphylactic shock, CAN BE PAINFUL
–> Used for SEVERE CASES - Blood/Packed Red Cell transfusion
–> Used when patient is unstable/hypoxic PRIOR to Sx
INCREASED DESTRUCTION (lysis) of RBCs, can be either ____-____ or ____-____ _____
2 for first, 4 for second
IMMUNE-MEDIATED
1. IMHA
2. can be PRIMARY or SECONDARY to INFECTION/TOXIN/NEOPLASIA
NON-IMMUNE MEDIATED
1. OXIDATIVE DAMAGE (acetaminophen in cats, onion, garlic)
2. INTRA-ERYTHROCYIC PARASITES (Babesia spp, mycoplasma haemofelis)
3. MECHANICAL DAMAGE (microangiopathic anemia, HSA)
4. CONGENITAL ERYTHROCYTE ENZYME DEFICIENCY (PFK or PK deficiency)
4 reasons for RETICULOCYTE COUNT NOT BEING INCREASED or ONLY MINIMALLY INCREASED in response to anemia?
what do we see no MCV/MCHC?
- PRE-regenerative anemia
- PRIMARY BONE MARROW DZ –> bone marrow itself NOT MAKING ENOUGH
- LACK of EPO from KIDNEY
- Diseases affecting BONE MARROW FUNCTION SECONDARILY
MCV/MCHC?
NORMOCYTIC & NORMOCHROMIC
PRIMARY bone marrow disease…
can ONLY HAVE CAUSE CONFIRMED using WHAT DIAGNOSTIC?
causes? (9)
= requires BONE MARROW SAMPLE to confirm cause!
causes?
1. Idiosyncratic drug reactions
2. Estrogen toxicity
3. Pure red cell aplasia
4. Aplastic pancytopenia
5. Myelofibrosis
6. Myelodysplastic syndromes
7. Feline RETROVIRUSES (FeLV, FIV)
8. Parvovirus
9. CHRONIC Ehrlichiosis
if a cat comes in with NON-REGENERATIVE anemia & not doing well, WHAT DIAGNOSTIC SHOULD WE RUN? why?
FeLV & FIV TESTING because these are feline RETROVIRUSES that can cause PRIMARY BONE MARROW DISEASE
PARVOVIRUS..
often causes WHAT kind of anemia?
pathophys?
2 other clinical signs?
causes…
= NON-REGENERATIVE ANEMIA and PRIMARY BONE MARROW DZ
pathophys?
–> INVADES & DESTROYS RAPIDLY PROLIFERATING INTESTINAL EPITHELIUM & BONE MARROW PRECURSOR CELLS
2 other clinical signs?
1. DIARRHEA
2. PANLEUKOPENIA
CHRONIC EHRLICHIOSIS…
2 hematologic findings?
commonality?
what puts dogs at an INCREASED RISK?
2 hematologic findings?
1. Lymphopenia
2. Thrombocytopenia
commonality?
= Develops ONLY IN SOME INFECTED DOGS
increased risk?
= Dogs on doxycycline for >30 DAYS can be at INCREASED RISK
5 diseases that can SECONDARILY affect BONE MARROW FUNCTION?
what kind of anemia does this cause?
- Iron deficiency/unavailability
- Hypocobalaminemia (low vitamin B12)
- Chronic liver disease
- Endocrine diseases (hypothyroidism, hypoadrenocorticism)
- Anemia of chronic disease
this causes NON-REGENERATIVE anemia!
what is HEPCIDIN?
what DISEASE PROCESS is it usually associated with?
hepcidin = POSITIVE ACUTE PHASE PROTEIN that INCREASES IN INFLAMMATION
usually associated with ANEMIA OF CHRONIC DISEASE where CHRONIC inflammation has occurred
ANEMIA OF CHRONIC DISESE
AKA what name?
= definition?
what TYPE of anemia? (2)
MCV/MCHC? (2)
TREATMENT?
AKA anemia of CHRONIC INFLAMMATION
= ANY type of inflammation will INCREASE POSITIVE ACUTE PHASE PROTEINS in CHRONIC FASHION
type of anemia?
1. MILD
2. NON-REGENERATIVE anemia
MCV/MCHC?
1. Normocytic
2. Normochromic
treatment?
–> NO SUPPLEMENTATION NECESSARY, just need to RESOLVE INFLAMMATION!
identify DISEASE & TYPE OF ANEMIA
HYPOCOBALAMINEMIA (vitamin B12 deficiency)
NON-REGENERATIVE ANEMIA
HYPOCOBALAMINEMIA
causes WHAT TYPE of anemia?
congenital in WHAT 3 breeds?
associated with WHAT MAIN DISEASE CATEGORY & 2 examples?
4 hematology findings?
BIG FINDING ON BLOOD SMEAR?
NON-REGENERATIVE ANEMIA
CONGENITAL IN…
1. Border collies
2. Beagles
3. Giant Schnauzers
Associated with SEVERE ENTEROPATHY
1. IBD
2. Neoplasia
Hematology?
1. MILD, non-regenerative
2. Normocytic
3. Normochromic
4. MARKED neutropenia
Blood smear?
= HYPERSEGMENTED neutrophils
diagnostic steps for NON-REGENERATIVE ANEMIA when we SUSPECT SOMETHING IS WRONG WITH BONE MARROW (4)
3rd step has 4 subs
(1) Establish PRESENCE & SEVERITY of anemia
(2) Evaluate HISTORY for DRUG-INDUCED HEMATOLOGIC disorder
(3) Test for DISEASES causing EPO suppression
–> Infectious (FIV/FeLV, Parvovirus, Chronic Ehrlichia)
–> Inflammatory diseases
–> Organ disease (CKD, liver disease)
–> Endocrine (hypothyroidism, hypoadrenocorticism)
(4) BONE MARROW ASPIRATION & CORE BIOPSY
what likely occurred here?
DOG HAS HEMOSTATIC DISORDER, CAUSED HEMATOMA FROM JUGULAR DRAW
in NORMAL patients, 1 PLT/HPF = ???
15 x 10^3
what can happen when using a EDTA or citrate tube for platelet counts? (2)
- platelets appear ARTIFICIALLY LOW due to CLOTTING
- platelet AGGREGATES can be COUNTED AS WBCs
what should we ALWAYS do to get an accurate platelet assessment?
A BLOOD SMEAR along with hematology
ID disease
CONGENITAL MACROTHROMBOCYTOPENIA
CONGENITAL MACROTHROMBOCYTOPENIA…
= definition
mostly in WHAT BREED?
inherited as…
confirmatory diagnosis? (2, include something about if certain breed has it)
platelet count?
risk of bleeding?
treatment?
= platelets LOW IN NUMBER & VERY BIG
mostly in CAVALIER KING CHARLES SPANIELS
inherited as AUTOSOMAL RECESSIVE trait
confirmatory diagnosis?
1. GENETIC TEST can CONFIRM WHETHER ANIMAL IS AFFECTED OR NOT
2. In a King Charles, low platelet count is enough supporting evidence
platelets usually 50,000 –> 100,000/uL, but can be SEVERE (<30,000)
DO NOT SEE INCREASED RISK OF BLEEDING
NO THERAPY NEEDED
4 reasons for THROMBOCYTOPENIA?
- DECREASED PRODUCTION
- INCREASED CONSUMPTION
- INCRAESED SEQUESTRATION/REDISTRIBUTION
- INCREASED DESTRUCTION
pancytopenia definition
= when ALL HEMATOPOIETIC PRECURSORS ARE DEPLETED/DECREASED
reasons for INCREASED DESTRUCTION causing THROMBOCYTOPENIA? (3, 2 subs for first point describing what it is)
what kind of thrombocytopenia do we usually see?
reasons?
1. IMMUNE-MEDIATED THROMBOCYTOPENIA
–> Platelets can be destroyed in periphery OR in bone marrow
–> Can be primary or secondary
2. Autoimmune/idiopathic
3. Drug reactions
what kind of thrombocytopenia?
–> USUALLY SEVERE THROMBOCYTOPENIA (<20,000/uL)
reasons for INCREASED CONSUMPTION causing THROMBOCYTOPENIA (3 main, 3 subs first & 2 subs second)
- Intravascular COAGULATION
–> DIC
–> Vascular neoplasia
–> Thrombosis - Vasculitis
–> Heartworm disease
–> Bacterial infection - Acute & severe blood loss
DECREASED PRODUCTION causing THROMBOCYTOPENIA…
= describe what happens
often due to…. (+ 2 examples)
in cats, WHAT SHOULD WE SUSPECT?
= Destruction of MEGAKARYOCYTES in bone marrow, so BONE MARROW NOT MAKING ENOUGH PLATELETS
Often a DRUG REACTION
1. CHEMOTHERAPY
2. RADIATION
in CATS = FIV/FeLV
INCREASED SEQUESTRATION/REDISTRIBUTION & thrombocytopenia
what ORGAN is enlarged? & what 2 things can we see as to why?
2 other signs?
what KIND of thrombocytopenia do we see?
SPLEEN –> SPLENOMEGALY
1. Splenic torsion
2. Splenitis
2 other signs?
1. Severe hypothermia
2. Endotoxemia
MILD TO MODERATE thrombocytopenia
if there’s an issue with PRIMARY HEMOSTASIS, should we expect CHANGE IN CLOTTING TIMES? why or why not?
YES!! PRIMARY HEMOSTASIS = DRIVEN BY PLATELETS, SECONDARY = DRIVEN BY CLOTTING FACTORS/FIBRIN
we would expect cavitary bleeding in an disease affecting PRIMARY hemostasis (true/false)
FALSE
4 general DIAGNOSTICS we perform for THROMBOCYTOPENIA patients?
hint: include 2 subs for third, and one of them is +/-
- CBC = evaluate for other cytopenias & check for ANEMIA
- VECTOR-BORNE DZ SCREENING for diseases that cause thrombocytopenia
- IMAGING to screen for inflammatory, infectious, or neoplastic DZ
–> Thoracic rads
–> Abdominal US - +/- bone marrow aspirate
