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Clin Path > Exam 1: Lecture 6 & 7 > Flashcards

Exam 1: Lecture 6 & 7 Flashcards

0
Q

physical findings

A

clinical signs of anemia +

  • icterus
  • hemoglobinuria (hemoglobin in urine, it will be red. you know its not RBCs bc when you spin it down you wont have any serum)
  • hemorrhage
  • fever
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1
Q

important historical info:

A
  1. prior drug administration
  2. exposure to toxic plants or chemicals
  3. family or herd occurrence (look for something in common)
  4. recent transfusion or colostrum (will pump up PCV and make you think anemia is not as bad as it actually is)
  5. age at onset of anemia
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2
Q

how do you tell the difference between hemorrhage and hemolysis

A

your TP
DECREASED for hemorrhage bc you are losing proteins to the outside world
NORMAL for hemolysis bc whether its intravascular or extravascular you are still able to recycle those proteins to use them again

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3
Q

what will confirm a regenerative anemia

A

increased polychromasia

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4
Q

what is suggestive of a regenerative anemia

A

a macrocytic hypochromic anemia - big cells and less Hgb. but only polychromatophils can confirm a regenerative anemia

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5
Q

if an animal is on prednisone and you see microcytosis what type of anemia do you think its?

A

Fe deficiency anemia. slide should be hyperchromic and has been bleeding out of the butt

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6
Q

EXAM Q: what are the 3 diseases that increase heinz bodies

A
  1. diabetes
  2. lymphoma
  3. hyperthyroidism
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7
Q

mild anemia is typically due to what?

A

anemia of chronic inflammatory disease

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8
Q

what does macroagglutination indicate?

A

intravascular hemolysis

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9
Q

how do you determine the difference between intravascular and extravascular hemolysis?

A

hemoglobinemia differentiates between the two of them

an increased bilirubin concentration can be seen in both

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10
Q

what should be evaluated to create differential diagnoses of anemia

A
  • plasma appearance
  • plasma concentration
  • reticulocyte count (if its super low, you know its non-regenerative)
  • RBC morphology
  • bone marrow evaluation
  • coombs test (looking for immunoglobulins and complement)
  • plasma bilirubin concentration
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11
Q

what are the pathophysiologic mechanisms that classify anemia?

A
  • hemorrhage
  • accelerated RBC destruction (hemolysis)
  • reduced or defective erythropoiesis
  • hemodilution
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12
Q

hemodilution “anemia”

A

its not really anemia, its usually something that creates a temporary mild anemia.

  • pregnancy (increased extravascular space causes “anemia”)
  • postnatal growth: growing so fast
  • splenic sequestration (splenomegaly, anesthesia, heparin tx in horses)
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13
Q

what will cause young animals to frequently have a physiologic anemia (hemodilution)?

A
  • rapid growth rate will cause hemodilution from plasma volume expansion
  • dilutional from colostrum
  • destruction rate of fetal RBCs (goats have a diff. fetal Hgb)
  • decreased production due to low erythropoietin concentrations early in life)
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14
Q

EXAM Q: what is the difference between HCT and PCV?

A

PCV is spun down in a crit tube, HCT is figured out on analyzer as a calculation. we always go with PCV bc even though numbers are identical, it can’t be messed up

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15
Q

EXAM Q: how do you know whether an anemia is regenerative or non-regenerative?how can you confirm a regenerative anemia?

A
  • increased polychromasia

- absolute reticulocytosis

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16
Q

what is regenerative anemia due to? ie what causes a regenerative anemia?

A

hemorrhage or hemolysis

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17
Q

what will you typically see with regenerative anemia?

A
  • nRBCs
  • basophilic stippling
  • increased micronuclei (howell-jolly bodies)
  • polychromasia <– confirms regenerative anemia
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18
Q

what will you see with a severe hemolytic anemia?

A
  • stressed retics = huge polychromatophils
  • spherocytes
  • this combo of big and small RBCs will give you a HIGH RDW and ansiocytosis
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19
Q

what does a very pale (particularly in the center) RBC inidicate?

A

Fe deficiency anemia

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20
Q

what do stressed retics due to MCV and MCHC?

A

increase MCV

decrease MCHC

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21
Q

what are signs that you have a hemolytic anemia?

A

icterus (bilirubin)

hemoglobinuria

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22
Q

what causes increased bilirubin in hemolytic anemia?

A

you will see bilirubin bc of RBC destruction. bilirubin is a breakdown product of hemoglobin. bilirubin is processed in the liver. when looking for increased bilirubin, it will go to urine first, then blood, then tissues.

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23
Q

what differentiates between intra and extravascular hemolysis?

A

hemoglobin in urine (hemoglobinuria) and hemoglobinemia

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24
Q

why is it impt to differentiate between roulaeux and agglutination?

A

bc if its agglutination, animal will be put on immunosuppressive drugs which is the last thing you want to do if its roulaeux bc roulaeux is caused by increase fibrinogen which is a result of inflammation which usually occurs when there is an infection.

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25
Q

what test do you run to differentiate between rouleaux and agglutination?

A

saline test! if they disperse its rouleux, if they clump together, its agglutation.

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26
Q

is anemia regenerative or non-regenerative with hemolysis?

A

regenerative, always

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27
Q

what will your plasma protein concentration be with hemorrhage? increased or decreased?

A

decreased

28
Q

what lab findings will you find with hemolytic anemia?

A
  • increased plasma concentration

- reticulocyte counts will be higher (bc you aren’t losing stuff to the world)

29
Q

what will you find with extravascular hemolysis that you won’t see in intravascular?

A

like being drunk at your friends house (=ok)

  • abnormal rapid RBC death but in a normal location like spleen, liver or bone marrow
  • can be acute or chronic
  • DIC Is possible
  • more common
30
Q

what will you see in intravascular hemolysis that you wont see in extravascular?

A

like being drunk in public (= bad)

  • abnormally rapid RBC destruction AND in abnormal location
  • usually rapid (acute)
  • occurs in bloodstream
  • increased circulating RBC fragments increase for DIC and anaphylactic shock
31
Q

hyperalimentation: what is it and when does it happen?

A

its when the body is desperately trying utilize glucose and ATP but the RBCs dont get any - its bad.

seen in re-feeding syndrome

32
Q

hypophosphatemia

A
  • decreased RBC ATP concentration
  • hyperalimentation (think re-feeding syndrome)

occurs bc you have decreased ATP trying to keep up with RBC membrane

33
Q

what are some common causes of blood loss anemia?

A
  • platelet disorders (rare)
  • neoplasia (#1 cause for blood loss in feces)
  • inflammatory bowel disease
34
Q

walk thru this situation. you have a crit tube with no buffy coat. its pink. you have an analyzer reading of same sample that says you have 117,000 WBC count and a 19% HCT. what type of anemia is this?

A
  1. no buffy coat = no WBCs or platelets but analyzer says you have a normal amount, so WBCs is wrong
  2. pink plasma = hemogloinemia which means you have hemoglobin in the blood which indicates hemolysis.
  3. HCT of 19% = anemia
  4. hemolysis = regenerative anemia

conclusion: regenerative anemia

35
Q

external hemorrhage: what should PCV and TP look like?

A

both decreased bc you are losing RBCs and plasma proteins and iron to the world or a parasite

36
Q

internal hemorrhage: what does PCV and TP look like?

A 
decreased PCV
increased TP (bc you will have high fibrinogen bc there is inflammation going on)
  • iron is conserved
  • may have a slight hyperbilirubinemia
37
Q

causes of acute hemorrhage

A
  • trauma
  • bleeding ulcers (rimadyl with no gastroprotectant)
  • bleeding tumors (large breed dogs are poster child)
  • severely marked decrease in platelets (< 20 - 25,000 microliters)
  • inherited or acquired coagulopathies (ie no co ag factors and you bleed out)
38
Q

EXAM Q: if you see a decreased PCV and a decreased TP what should your top differential be?

A

external hemorrhage

39
Q

will HCT change if you have external hemorrhage?

A

no - because HCT is a percentage of MCV and RBC. if you are losing blood in equal proportions, it wont change!

40
Q

does acute hemorrhage cause thrombocytopenia?

A

no!

41
Q

EXAM Q: how do you confirm regenerative anemia in a horse?

A

you have to do either a serial PCV or a bone marrow bc you will NEVER see polychromatophils in a horse which is the normal way of confirming regenerative anemia

42
Q

EXAM Q: what are the 3 common RBC morphologies you will see with hemolysis?

A

shistocytes, keratocytes, acanthocytes

43
Q

what is seen with chronic blood loss?

A
  • a regenerative response to anemia however once iron defiency develops it will become non-regenerative
  • hypoproteinemia
  • thrombocytosis
  • RBC morphologies consistent with hemolysis
44
Q

if you have data suggestive of Fe deficiency anemia would should definitely be a differential?

A

thrombocytosis

45
Q

what are some common sources of external blood loss? (what is the number one most common source?)

A

1 most common source of blood loss = GI tract

  • bleeding ulcers
  • parasites
  • flea infestation
46
Q

EXAM Q: what is something that positively effects the production of RBCs?

A

iron and erythropoietin (factor made by kidney that leads to increased RBC mass)

47
Q

when is erythrocytosis seen?

A

erythrocytosis = more RBCs than you should

  • dehydration
  • hyperthyroidism
48
Q

causes of iron deficiency anemia?

A
  • dietary deficiency of iron (seen only in pigs)
  • copper deficiency
  • chronic external blood loss
49
Q

what type of anemia do cats with chronic renal failure have?

A

normocytic, normochromic, non-regenerative anemia bc they have no kidney mass left to make erythropoietin

50
Q

EXAM Q: will have a pic of dog blood with >1/2 central pallor and lots of shape abnormalities - like keratocytes and shistocytes. what is it caused from?

A

chronic blood loss resulting in Fe deficiency anemia

51
Q

EXAM Q: what type of anemia is chronic inflammatory disease?

A

normocytic, normochromic

52
Q

what do you see with decreased erythrocyte production?

A
  • non-regenerative anemia
  • anemia is usually normocytic: bc most non-regenerative anemia is normocytic bc macrocytic hypochromic is associated with polychromatophils which = regeneration.
53
Q

what are some causes of microcytic anemia?

A
  • Fe deficiency
  • chronic inflammatory disease
  • copper deficiency
54
Q

EXAM Q: what is the #1 reason for non-regenerative anemia?

A

anemia of chronic inflammatory disease

55
Q

what do you see with non-regenerative anemias?

A
  • reduced erythropoiesis (chronic renal disease)
  • hromone deficiencies (hypothryoid dogs have decreased metabolism and therefore decreased need for O2)
  • anemia of chronic inflammatory disease
56
Q

what is seen with anemia of chronic renal disease?

A
  1. decreased erythropoietin production <– main mechanism
  2. suppression of erythropoiesis (making of RBCs)
  3. decreased RBC lifespan
  4. hemorrhage (usually caused by uremia)
57
Q

EXAM Q: there is a cat with chronic renal disease. its super dehydrated. what should you do to manage it?

A
  1. GIVE FLUIDS!
  2. put them on a low protein diet to help BUN and keep kidneys lasting longer
  3. they dont have enough erythropoietin
58
Q

EXAM Q: what endocrine disorder can be the cause of a non-regenerative anemia?

EXAM Q: why?

A

hypothyroidism (sad face dogs) and and hypoadrenocorticism

bc they have a decreased metabolism so they have a decreased need for O2 consumption which leads to a mild, non-regenerative anemia

59
Q

what type of anemia is inflammatory disease?

A

non-regenerative, normocytic, normochromic

60
Q

EXAM Q: classic case –> decreased MCHC, decreased MCV.

  1. what type of anemia is this?
  2. after awhile, you have developed low retic counts what is this an indication of?
  3. what is the cause?
A

microcytic, hypochromic

thrombocytosis

Fe deficiency anemia

61
Q

erythroid progenitors are seen doing what in bone marrow and spleen?

A

clustering around macrophages called “erythroblastic islands” bc they obtain their iron from these iron-storing cells as well as from circulating transferrin.

62
Q

polycytopenia

A

caused by tumor in which you have increased RBCs

have to bleed dog every couple weeks to prevent blood from getting sludgey

63
Q

what do red, glistening mm indicate?

A

dehydration

64
Q

most erythrocytosis is relative, meaning _______?

A

caused by being super dehydrated, artificially increasing RBC mass

65
Q

what is relative erythrocytosis usually caused from?

A
  1. dehdyration t have as much plasma and your RBCs are higher in a crit tube
66
Q

secondary erythrocytosis

A
  • increased erythropoietin
  • seen with hypoxemia (high altitude, heart disease, chronic lung disease, methemoglobinemia)
  • inappropriate EPO production (like renal tumors)
67
Q

primary erythrocytosis

A
  • normal or low erythropoietin

- polycythemia vera (bone marrow disease that increases RBCs)

Clin Path (6 decks)

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