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Medicine III > Equine Anemia > Flashcards

Equine Anemia Flashcards

1
Q

What is Anemia?

A
  • ​Decrease in circulating RBC mass
    • Decreased Pack Cell Volume
    • Decreased RBC
    • Hemoglobin decreased except with intravascular hemolysis
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2
Q

What sites for Bone Marrow Biopsy are used in horses?

A
  • Rib
  • Sternum
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3
Q

What are the (broad) causes for anemia?

A
  • Blood loss
  • Destruction/Hemolysis
  • Decreased Production
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4
Q

How is Regenerative vs. Non-regenerative anemia determined in horses?

A
  • Horses do NOT release immature RBC into peripheral circulation
  • May see a mild increase in anisocytosis and MCV
  • Only way to determine Regenerative is w/ bone marrow biopsy
    • or wait 3 days to see if RBC# increases
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5
Q

How can Internal hemorrhage and external hemorrhage be differentiated (I.e. GI bleed into lumen vs hemothorax)

A
  • Internal: bleeding into the body cavity, ~⅔ of RBCs are autotransfused back into circulation w/in 24-72hrs
    • rest are phagocytized back - iron is reused
  • External: blood is lost to outside, iron is lost
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6
Q

What are the clinical signs of Blood Loss Anemia?

A
  • Increase in HR & RR
  • Pale mucous membranes
  • poor venous distention
  • weakness
  • fainting
  • Frequently have heart murmur
    • changes in blood viscosity
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7
Q

How is Blood loss Anemia diagnosed?

A
  • PCV and TP initially normal
    • Start reduction by 4-6hrs, takes up to 24hr for complete redistribution
  • Splenic Contraction - adds RBC to peripheral blood
  • Regeneration of RBC should start to be evident at 3 days, max response in 7 days
  • PCV will increase about 1% or less a day
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8
Q

What is the treatment for Blood loss anemia?

A
  • Stop the bleed
    • surgical hemostasis
    • aminocaproic acid
    • Yunnan Baiyo
    • Formalin
  • IV fluids - for severe acute hemorrhage - restore ‘volume’
  • Blood transfusion -
    • signs of shock (PCV from 18% to 12% depends on speed of bleed)
      • Acute < 15-18%
      • Chronic <12%
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9
Q

What is Blood transfusion crossmatching?

A
  • Major cross match: compatibility between donor RBC and any alloantibody in patient’s plasma
  • Minor cross match: compatibility between alloantibody in donor’s plasma and patients RBC
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10
Q

What is a ‘universal donor’ for equine blood transfusions

A
  • Donors that do not have Aa or Qa blood types
    • also lack Aa or Qa antibodies in plasma
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11
Q

What are the clinical signs of Chronic Blood loss?

A
  • Animals will tolerate a much lower PCV than with acute blood loss
  • Weight loss
  • ill thrift
  • pale mucous membranes
  • heart murmur (viscosity related)
  • exercise intolerance
  • signs of shock if severe enough
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12
Q

How is chronic blood loss diagnosed?

A
  • Find source of blood loss
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13
Q

What is the treatment for chronic blood loss?

A
  • stop bleeding
  • supplement with dietary iron if necessary
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14
Q

what causes Chronic Blood loss?

A
  • Immune mediated destruction
  • Oxidative injury to the RBC
  • Infectious agents
    • may increase RBC fragility
    • may induce IMHA
  • Iatrogenic
    • hypo or hypertonic drugs
  • Liver or Renal hemolysis
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15
Q

How can intravascular hemolysis and extravascular hemolysis be differentiated?

A
  • Intra:
    • Hemoglobinemia (pink plasma)
    • icterus
    • hemoglobinuria (red/brown urine)
  • Extra:
    • intense icterus
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16
Q

What is Immune Mediated Hemolytic Anemia? (IMHA)

A
  • Antibodies to RBC
17
Q

What are the clinical signs of IMHA in Horses?

A
  • Depend on intra/extravascular hemolysis
  • Fever
18
Q

What bloodwork is common in horses with IMHA?

A
  • Anemia
  • +/- pink plasma (intravascular hemorrhage)
  • ⇡ total & indirect bilirubin
19
Q

how is IMHA diagnosed?

A
  • Detection of antibody on RBC
    • Coomb’s test
    • Direct immunofluorescence/Flow cytometry
      • IgG, IgA, IgM
    • Autoagglutination
20
Q

What causes false negatives on a Coomb’s test?

A
  • Use of steroid prior to testing
  • rapid hemolysis of RBC that have antibody on them
21
Q

What causes IMHA in horses?

A
  • Drugs - penicillin
  • Infectious agents
    • equine infectious anemia
    • streptococcal
    • clostridial infections
    • Piroplasmosis
  • Neoplasia - lymphosarcoma
  • Maternal antibody - neonatal isoerythrolysis
  • Idiopathic IMHA
22
Q

What is the treatment for IMHA in horses?

A
  • Stop all previously administered drugs
  • remove/treat underlying disease
  • immunosuppression (steroids)
  • blood transfusions (if necessary - concern for reactions)
  • prevention of hemoglobin induced nephrotoxicity (use of fluids)
23
Q

What does oxidative injury do to RBCs?

A
  • Heinz body formation
    • oxidized, precipitated hemogglobin
    • appear as round, blue-black granules on RBC membrane
      • can see w/ New Methylene Blue stain
    • Result in damage to RBC membrane → Invtravascular hemolysis
  • methemoglobinemia
    • heme iron oxidized from ferrous to ferric
    • Can’t carry oxygen
    • Mucus membranes will appear brown
24
Q

What causes Oxidative injuries to RBCs in horses?

A
  • Wilted Red Maple leaves (Acer rubrum)
  • Wild onions - n-propyl disulfide
  • phenothiazines
  • Nitrate poisoning - methemoglobin only → no intravascular hemolysis
25
Q

What are the clinical signs of Red Maple toxicosis?

A
  • Rapid death
  • several days of hemoglobinuria
  • brown mucus membranes
  • high heart rate
26
Q

How is Oxidative RBC injury diagnosed?

A
  • Rule out IMHA
  • look for Heinz bodies
  • Methemoglobinemia (normal <1.77%)
    • Red Maple can cause up to 50%
27
Q

How is RBC Oxidative Injury treated?

A
  • Blood transfusions may be necessary
  • fluids to prevent hemoglobin-induced nephrotoxicity
  • Large doses of Vit C
  • Supportive Care
28
Q

What causes Nonregenerative Anemia in horses?

A
  • Anemia of chronic disease - common (mild anemia)
  • Iron deficiency - uncommon
  • Bone Marrow Suppression - rare
    • drugs or neoplasia
29
Q

What does Anemia of Chronic disease look like? (on blood smear)

A
  • Mild to moderate anemia
  • Normocytic
  • normochromic
  • non-regenerative
  • Does NOT result in clinical signs
    • treatment not necessary
30
Q

What is the pathophysiology of Anemia of Chronic Disease?

A
  • Basic cause - lack of iron mobilization
    • inflammation results in increased production of hepcidin (protein from the liver)
      • ⇡Hepcidin → ⇣Ferroportin → iron trapped intracellularly (not available for RBC production)
31
Q

What is Ferroportin? purpose?

A
  • Transmembrane protein present on enterocytes, macrophages, liver cells
  • Transports iron out of the cell
32
Q

How is Anemia of Chronic Disease Diagnosed?

A
  • Mild anemia and chronic disease
  • Bone Marrow - document non-regenerative anemia
  • Serum iron conc. ⇣
    • indices of iron storage are normal
33
Q

What is Iron deficiency? what does it look like on blood smear? causes?

A
  • Uncommon
  • Serum iron concentrations decreased
    • indices of iron storage also decreased (ferritin, bone marrow staining for iron)
  • Blood Smear:
    • non-regenerative
    • microcytic
    • hypochromic
  • Cause: chronic external blood loss
34
Q

What causes Bone Marrow Suppression in horses?

A
  • Drugs:
    • recombinant human erythropoietin
      • autoantibodies that cross react with equine erythropoietin
    • SMZ (pancytopenia)
  • Neoplasia - myelophthisis
    • accumulation of abnormal cells in bone marrow
  • Viral - Equine Infectious Anemia
  • Chronic Renal Failure
    • lack of erythropoietin production
35
Q

What is Hepcidin?

A
  • Antimicrobial peptide
  • Produced in the liver secondary to inflammation
  • Destroys ferroportin

Medicine III (32 decks)

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