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Exam 2 - Equine Anemia Flashcards

1
Q

what hormone is produced by the kidneys that erythropoiesis is dependent upon? why is this important to remember for animals with chronic renal failure?

A

erythropoietin

chronic renal failure animals will often have a non-regenerative anemia due to loss of erythropoietin

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2
Q

what is the action of erythropoietin?

A

stimulates the bone marrow to crank out RBCs

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3
Q

when is erythropoietin released by the kidneys?

A

in response to renal hypoxia

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4
Q

how do you determine if anemia is regenerative in most species? does this work in horses? why?

A

look for the presence of reticulocytes

doesn’t work in horses - reticulocytes are not released into circulation even with highly regenerative anemia!!!!!!

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5
Q

what do we use to determine if a horse has a regenerative anemia?

A

RBC regeneration is determined by RBC size & bone marrow aspirates

macrocytosis - increased MCV - correlates with regenerative anemia

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6
Q

how long do equine RBCs live in the bloodstream?

A

normal - remain in circulation for 150 days before removal via mononuclear phagocytes in the spleen, liver, & bone marrow

after this - heme is converted to biliverdin & then to bilirubin which is released unconjugated into the bloodstream

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7
Q

what RBC indices are decreased in a horse with iron deficiency anemia?

A

MCV - mean corpuscular volume & MCH - mean corpuscular hemoglobin

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8
Q

what RBC indices are increased with intravascular hemolysis?

A

MCH - mean corpuscular hemoglobin & MCHC - mean corpuscular hemoglobin concentration

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9
Q

T/F: rouleaux formation in horses is a normal finding on a blood smear

A

true

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10
Q

what is a poikilocyte?

A

any abnormally shaped erythrocyte

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11
Q

what is anisocytosis?

A

variability in RBC size usually associated with an increased RBC distribution

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12
Q

what is polychromasia?

A

variability in RBC color, usually due to variable hemoglobin concentration

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13
Q

what is a spherocyte?

A

sphere-shaped RBC that may be observed in hemolytic anemias

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14
Q

what are echinocytes?

A

‘burr cell’ - short, regularly spaced spicules projecting from the cell surface

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15
Q

what are acanthocytes?

A

spur cell with irregularly shaped spicules extending from the RBC surface that are associated with liver disease or gi malabsorption

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16
Q

what are elliptocytes?

A

ellipsoid or oval erythrocyte found in animals with iron deficiency or myelophthisic anemia

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17
Q

what are leptocytes?

A

thin, flat RBC frequently associated with hepatic disease or iron deficiency

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18
Q

what are codocytes?

A

target shaped cell with dense central area of hemoglobin surrounded by a pale zone that is associated with hypochromic anemias or hepatic disease

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19
Q

what are howell-jolly bodies?

A

basophilic nuclear remnants seen in the cytoplasm of erythrocytes - normal finding

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20
Q

what are heinz bodies?

A

oxidized precipitated hemoglobin indicating oxidative damage to RBCs usually resulting in intravascular or extravascular hemolysis (red maple toxicity)

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21
Q

what staining is used to best see heinz bodies on a blood smear?

A

new methylene blue stain

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22
Q

if you see auto-agglutination on a blood smear, what does it mean?

A

intravascular hemolysis is present

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23
Q

what is the difference between a direct & indirect coomb’s test?

A

direct - detects Ig or complement on the RBC surface

indirect - detects anti-RBC antibodies on the RBC surface

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24
Q

T/F: to properly evaluate & interpret bone marrow, a CBC MUST be performed at the same time that the marrow sample is collected

A

true

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25
what are the advantages of using an FNA for bone marrow evaluation?
easier to obtain than a core biopsy processed & evaluated on the same day of collection better assessment of cellular morphology
26
what are the advantages & disadvantages of using a core biopsy for bone marrow evaluation?
advantages - better assessment for overall cellularity disadvantages - sample must be fixed, decalcified, sectioned, stained, & processing may take 1-3 days
27
what is the most common collection site used for bone marrow evaluation in adult horses?
sternabrae - 4th, 5th, or 6th
28
why avoid using the 7th sternabrae for a bone marrow biopsy in a horse?
heart lies adjacent to it - avoid cardiac puncture
29
what is myelophthisis?
reduction in all cellular elements in bone marrow - seen in bone marrow fibrosis
30
what does the presence of myelodysplasia indicate?
presence of abnormal cells - myeloproliferative neoplasia
31
what is myelodysplasia?
type of cancer in which the bone marrow does not make enough healthy blood cells (white blood cells, red blood cells, and platelets) and there are abnormal cells in the blood and/or bone marrow
32
how would you diagnose hemoabdomen in a horse?
use an ultrasound to evaluate for hemoperitoneum - will see free echogenic fluid in the peritoneum & swirling of cells may be seen
33
what are signs of hemoperitoneum in a horse?
clinical signs resemble acute colic!!! hypovolemia - tachycardia, tachypnea, pale MM, crt >2, & elevated lactate ultrasound - free echogenic fluid with swirling cells abdominocentesis - peritoneal fluid with a high PCV & protein
34
how do you manage a horse with hemoperitoneum?
hemodynamic stabilization fluids/transfusions prognosis depends on severity of bleed & underlying cause
35
how do you diagnose hemothorax in an adult horse?
clinical signs of pleural effusion, anemia, or hemorrhagic shock ultrasound & thoracocentesis for pleural fluid analysis auscultation, palpate for rib fx, coagulation panel, & look for pleurodynia
36
what does fresh blood look like on ultrasound?
hyperechoic, swirling pattern
37
how do you manage a horse with hemothorax?
conservative if patient is hemodynamically stable - treat underlying causes (stabilize any rib fractures) pleural drainage if volume/blood is producing hypoxemia/respiratory distress prefer not to drain until hemorrhage has stopped broad spectrum abx, iv fluids, & transfusions if needed
38
what are some causes of intestinal blood loss in horses?
post-op from: enterotomy, intestinal R&A, or treatment stomach ulcers ulcerative colitis melena
39
what are some examples of causes of pulmonary hemorrhage in horses?
exercise induced pulmonary hemorrhage massive pulmonary thromboembolism (tachycardia, epistaxis, hemoptysis, & sudden death) inhalation of foreign bodies coagulopathy neoplasia/pulmonary abscessation
40
why would we give a horse IV phenylephrine?
help with nephrosplenic entrapment
41
T/F: horses older than 15 that are given phenylephrine for nephrosplenic entrapment are at a 64x greater risk of hemorrhaging
true
42
why do we see hemorrhage in peri-parturient mares?
major uterine arteries!!!! fibrosis of arterial walls causes loss of elasticity affects 2-3% of broodmares, compromises 17% of post-partum emergency admissions, & accounts for 40% of post-partum deaths in mares
43
what are some risk factors for hemorrhage in peri-parturient mares?
older age multiparity dystocia previous hemorrhage
44
when do we see hemorrhage in peri-parturient mares occur?
usually develops within 48 hours after parturition can occur as early as the 5th month & as late as 4 months after parturition
45
what are some clinical signs of hemorrhage in peri-parturient mares?
colic, hypovolemic shock, vaginal bleeding, ataxia, & recumbency clinical pathology - recent blood loss, PCV/TP often still normal but will decline over time
46
how is hemorrhage in peri-parturient mares diagnosed?
ultrasound (transrectal or transabdominal)
47
why do most clinicians avoid trans-rectal palpation for diagnosing hemorrhage in peri-parturient mares?
palpation can disrupt the clot - extreme caution
48
T/F: complications occur in 80% of surviving mares with peri-parturient hemorrhage
true
49
what are some common complications seen in surviving mares with peri-parturient hemorrhage?
fever, retained fetal membranes, laminitis, arrhythmias, colic, colitis, & peritonitis
50
how is hemorrhage in peri-parturient mares treated?
cardiovascular stabilization - correct hypovolemia pro-coagulant drugs pain management abx anti-inflammatories avoid surgical exploration unless you suspect a GI lesion
51
what is idiopathic renal hematuria?
syndrome characterized by the sudden onset of gross, often life-threatening hematuria with hemorrhage arising from one or both kidneys with an unknown etiology
52
what is the common signalment of horses affected by idiopathic renal hematuria?
over 50% of cases reported - arabians no sex or age predilection
53
what are the clinical signs seen with idiopathic renal hematuria?
hematuria hemorrhagic anemia - tachycardia, tachypnea, pallor, & can have hemorrhagic shock blood clots in bladder & kidney seen from ultrasound or endoscopy
54
how is idiopathic renal hematuria diagnosed?
diagnosis of exclusion - must rule out systemic disease, other causes of hematuria, & alterations in hemostasis
55
what is seen on endoscopic examination in a horse with idiopathic renal hematuria?
reveals no abnormalities of the urethra & bladder may see blood clots exiting one or both ureteral orifices
56
how is idiopathic renal hematuria treated?
support for acute blood loss aminocaproic acid or formalin if unilateral or recurrent, consider nephrectomy
57
why do you have to be aware of renal function of a horse with intravascular hemolysis?
in intravascular hemolysis, hemoglobin is released into the bloodstream which is then transported to the liver by haptoglobin if haptoglobin is saturated, there is free hemoglobin in the blood which is then filtered across glomeruli & reabsorbed by renal tubular epithelial cells heme is nephrotoxic!!!
58
what are some examples of infectious causes of hemolysis in horses?
equine infectious anemia piroplasmosis leptospirosis
59
what are some immune-mediated causes of hemolysis in horses?
primary IMHA secondary IMHA - clostridial disease, streptococcal infections, rhodococcus, viruses, lymphoma, & penicillin drug reactions
60
what are some examples of iatrogenic causes of hemolysis in horses?
hypotonic fluids, hypertonic saline, formalin, & DMSO if not adequately diluted (always dilute to 10% or less)
61
what is a disease that causes hemolysis in foals?
neonatal isoerythrolysis - first 5 days of life
62
what are some oxidative causes of hemolysis?
red maple leaf toxicity!!!!! snake/bee envenomation, phenothiazines, consumption of onion/garlic/rape/kale/pistacia leaves
63
what is IMHA?
antibody mediated destruction of RBCs that can occur with or without IMTP either primary (autoimmune destruction of normal RBC) or secondary
64
what clinical signs are seen with IMHA in horses?
fever, lethargy, anorexia presence of icterus - due to the increase in indirect & total bilirubin regenerative anemia hemoglobinuria (pigmenturia)
65
what are some causes of pigmenturia?
hematuria, hemoglobinuria, & myoglobinuria
66
how do we differentiate between causes of hematuria?
hemoglobinuria & myoglobinuria have no RBC in urine where hematuria does hemoglobinuria has pink plasma while hematuria will form sediment at the bottom once spun down myoglobinuria will also have significant muscle enzyme elevations (AST & CK)
67
how is IMHA in horses diagnosed?
auto-agglutination of blood on a saline test is strongly suggestive of hemolysis, 100% sensitivity % 87% specificity flow cytometry - quantification of percentage of RBC that have antibodies (IgG, IgA, IgM) bound to the surface, more sensitive than coombs testing
68
T/F: flow cytometry can differentiate between primary & secondary IMHA
false - can't
69
how are horses with IMHA managed?
immunosuppressive drugs!!!! dexamethasone, prednisolone, or azathioprine
70
T/F: horse RBC are more susceptible to oxidant-injury than RBC of other species
true
71
why are horses more susceptible to oxidative hemolysis than other species?
horses reduce methemoglobin via a lactate-dependent pathway & they have a decreased glutathione reduction rate
72
what is the pathogenesis of oxidative hemolysis?
oxidants in the blood oxidize the heme iron in hemoglobin from Fe2+ to Fe3+ & forms methemoglobin osidation of sufhydryl group in Hb leads to protein denaturation & heinz body formation which compromises membrane integrity & makes RBCs more fragile in turn, they are removed from circulation
73
what are some examples of toxic substances that would result in heinz bodies for a horse?
kale, garlic, maple leaf, rape, & onion
74
how does a horse get red maple leaf toxicity?
they have to eat wilted leaves!!!!! leaves remain toxic for 30 days usually in the summer or fall following adverse weather gallic acid though to be the toxin
75
T/F: maple trees in autumn all look red
true, red maple, silver maple, & sugar maple
76
T/F: fresh red maple leaves aren't toxic
true
77
how much wilted red maples leaves will cause clinical signs?
ingestion of 1.5mg/kg will produce symptoms 3 g/kg is fatal
78
what clinical signs are seen in a horse with red maple leaf toxicity?
tissue hypoxia, lethargy, tachycardia, tachypnea, fever, hemoglobinuria, colic, renal insufficiency, muddy brown/chocolate brown/icteric mucus membranes
79
what abnormal laboratory values do you expect to see in a horse with red maple leaf toxicity?
anemia, azotemia, leukopenia/leukocytosis, total methemoglobin elevated (normal is <3% of total hemoglobin), heinz bodies, & hemoglobinuria
80
what is the prognosis of red maple leaf toxicity in horses?
very guarded
81
what are some complications seen in horses with red maple leaf toxicity?
fever is most common followed by colic, laminitis, DIC, & cecal impaction
82
how is a horse with red maple leaf toxicity treated?
supportive care/iv fluids/pain management/transfusion if needed mineral oil - reduce further absorption of toxin ascorbic acid as an antioxidant vitamin c (30-50 mg/kg IV every 12 hours diluted in saline) corticosteroids to decrease RBC destruction
83
what clinical signs does pistacia leaf toxicity cause in horses?
similar to red maple leaf toxicity hemolytic anemia, methemoglobinemia, renal failure, & death
84
what is pistacia leaf toxicity?
plant that is found in the SW/SE USA - syndrome similar to red maple leaf toxicity, leaves of the plant contain gallic acid
85
what is this toxic plant?
pistacia leaf
86
when do horses eat wild onion?
only eaten by horses once all other forages have been consumed
87
T/F: for horses with garlic & onion toxicity, horses will recover once they stop eating it
true
88
what clinical signs are seen in horses with garlic & onion toxicity?
hemolytic anemia, heinz bodies, & excessive sweating
89
what kind of hemolysis does bee & snake envenomation cause?
both intravascular & extravascular hemolysis
90
what clinical signs are seen in horses with bee & snake envenomation
intravascular & extravascular hemolysis thrombocytopenia, profound coagulopathy, increased bleeding, excessive thrombosis, & DIC
91
what treatment is done for horses with bee/snake envenomation?
supportive treatment & anti-venom
92
what are known side-effects associated with giving phenylephrine to a horse?
epistaxis, hemopthysis, hemothorax, hemoperitoneum, hemopericardium, collapse, & death

LA DX & TX II (44 decks)

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