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SA DX & TX I > Exam 3 - Companion Animal Anemia: Mechanisms & Work-Up > Flashcards

Exam 3 - Companion Animal Anemia: Mechanisms & Work-Up Flashcards

1
Q

what is anemia?

A

decrease in the amount of total RBC mass (O2 carrying)

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2
Q

what is the consequence of anemia?

A

decreased O2 carrying capacity

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3
Q

what does calculated hematocrit depend on?

A

MCV (mean corpuscular volume), agglutination, & machine accuracy

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4
Q

what are the species differences & things relative to the patient between dogs & cats when it comes to parameters of anemia?

A

dogs are anemic at a higher hematocrit than cats

young animals have a lower hematocrit

greyhounds have a higher hematocrit

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5
Q

what are the 2 classifications of anemia based off of mechanism?

A

regenerative & non-regenerative

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6
Q

what is the exception to regenerative anemia when it comes to loss & lysis?

A

early hemolysis/lysis

too soon to see a regenerative response - look at 3-5 days for one

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7
Q

what are the 2 mechanisms listed as causes for regenerative anemia?

A
  1. loss
  2. lysis
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8
Q

what are the 2 mechanisms listed as causes for non-regenerative anemia?

A
  1. systemic/inflammatory response - decreased production
  2. primary bone marrow disorder - decreased production
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9
Q

how do you differentiate between loss & lysis in regenerative anemia using total solids/total proteins?

A

in loss - decreased total solids, total solids from PCV/TS, total protein from the CBC, & albumin on chemistry panel

in lysis - total solids often within normal limits or may even be increased from dehydration (primary process)

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10
Q

what is the exception for a decreased TS in a regenerative anemia due to loss?

A

very acute bleeding!!!

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11
Q

what are some clin path abnormalities seen on a patient with non-regenerative anemia caused by a systemic/inflammatory response?

A

isosthenuria or azotemia

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12
Q

what are some causes of non-regenerative anemia attributed to a systemic/inflammatory response?

A

chronic inflammatory disease

hypothyroidism

chronic kidney disease - decreased responsiveness to EPO & decreased iron transport

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13
Q

what are some causes of non-regenerative anemia attributed to a primary bone marrow disorder?

A

toxicity

neoplasia - myelophthesis

immune mediated

infectious diseases - fungal or viral

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14
Q

what is an important clue seen on a CBC that lends support to a primary bone marrow disorder causing a non-regenerative anemia?

A

bicytopenia or pancytopenia

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15
Q

what is an important clue seen on a CBC that lends support to a primary bone marrow disorder causing a non-regenerative anemia?

A

bicytopenia or pancytopenia

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16
Q

what are some causes of non-regenerative anemia attributed to a pre-regenerative anemia?

A

acute hemorrhage or hemolysis

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17
Q

if investigating pre-regenerative anemia as a differential for a non-regenerative anemia, what should you do?

A

establishing chronicity is very important!!!

recheck serial lab work

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18
Q

what are some external causes of hemorrhage?

A

trauma

mucosal surfaces - GI, urinary, & nasal

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19
Q

what are some internal causes of hemorrhage where the RBCs are reabsorbed?

A

-body cavity (peritoneum, thorax, & pericardium)
-intraorgan (CNS, skin, +/- lungs)
-skin, often petechiae & ecchymoses

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20
Q

what is involved in extravascular hemolysis destroying RBC?

A

immune-mediated process involving the reticuloendothelial system

destruction within the spleen

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21
Q

what is involved in intravascular hemolysis destroying RBC?

A

-immune-mediated
-toxicity (drugs, zinc toxicity, metabolic)
-infectious: look for organisms in the RBC or a secondary immune-mediated process

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22
Q

what dog breeds have an associated cause of hemolysis?

A

springer spaniels & basenji dogs

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23
Q

what is the breed-associated cause of hemolysis in springer spaniels?

A

phosphofructokinase deficiency - lack of enzyme necessary for the stabilization of RBC

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24
Q

what is the breed-associated cause of hemolysis in basenjis?

A

pyruvate kinase deficiency - lack of enzyme necessary for the stabilization of RBC

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25
Q

what cat breeds are associated with osmotic fragility syndrome causing hemolysis?

A

oriental cat breeds, abyssinians, & somalis

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26
Q

what color can be seen on mucus membranes that could be concerning for hemolysis?

A

yellow/icteric

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27
Q

what are the categorizations of severity of anemia?

A

mild: > 28%
moderate: 18-28%
severe: <18%

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28
Q

what is the difference of microcytosis & macrocytosis when it comes to interpreting a CBC for an anemic patient?

A

microcytosis - small RBC
- Fe deficiency anemia or abnormal Fe metabolism
- breed specific (toy poodles, akitas)

macrocytosis - large RBC
- most likely regenerative
- also seen in FeLV disease

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29
Q

what measures the density of RBC?

A

MCHC - hemoglobin content

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30
Q

if an animal has an Fe deficiency anemia, what would you expect the MCHC to be?

A

hypochromic

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31
Q

what is the gold standard for reticulocyte counts?

A

actual or absolute count

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32
Q

what is the formula for the actual/absolute reticulocyte count?

A

total RBC count * reticulocyte %

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33
Q

what is the cut-off value for a non-regenerative anemia when looking at reticulocyte counts for dogs & cats?

A

dogs: <60,000

cats: <50,000

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34
Q

when looking at feline reticulocytes, what is the difference between aggregate & punctate types?

A

aggregate - younger reticulocytes
punctate - older/more mature

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35
Q

when looking at a CBC of an anemic patient, what do you think of with a low total solids? what if it’s normal or high?

A

if low - consider hemorrhage

if high - inflammatory disease or chronic hemorrhage

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36
Q

when looking at a CBC of an anemic patient, why may a thrombocytopenia be important?

A

hemorrhage - consumption

might be the cause of bleeding if severe (IMTP leading to blood loss)

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37
Q

T/F: you can have platelets that are WNL with certain rickettsial diseases

A

true

38
Q

if albumin, globulins, & cholesterol are all low on an anemic patient, what should you consider?

A

gi bleeding

39
Q

if albumin is low on an anemic patient, what differentials should you consider?

A
  • gi bleed
  • PLN
  • hepatic disease
40
Q

if an anemic patient has hyperglobulinemia, what differentials should you consider?

A
  • infectious disease
  • inflammatory process
  • neoplastic process
41
Q

if an anemic patient has hyperbilirubinemia, what differentials should you consider?

A

potential pre-hepatic hemolysis

42
Q

why is it important to visually inspect the serum of an anemic patient?

A

tells you if there is discoloration present

43
Q

what does it mean if the serum of an anemic patient is yellow or orange in color?

A

bilirubin - hemolysis

44
Q

what does it mean if the serum of an anemic patient is red in color?

A

hemoglobin is present - intravascular hemolysis

45
Q

what does it mean if the serum of an anemic patient is lipemic?

A

maybe endocrinopathy

46
Q

what is the most common cause of hemolytic anemia in cats?

A

mycoplasma & cytauxzoon felis

47
Q

if you suspect babesia causing anemia in your patients, where should you sample for a blood smear?

A

ear tips or nail beds

48
Q

what is the most common abnormality seen on a blood smear of an anemic patient?

A

thrombocytopenia

49
Q

what dog breeds are known to be associated with babesia causing anemia?

A

greyhounds & staffordshire terriers

50
Q

why are blood smears helpful in using for an anemic patient that you suspect has an infectious cause?

A

helpful for detecting infectious organisms in the RBC - babesia!!!

51
Q

what do spherocytes indicate on a blood smear?

A

lack of central pallor & microcytic - indicates macrophage destruction of cell & essentially always indicates immune-mediated destruction/extravascular hemolysis

52
Q

what do schistocytes indicate on a blood smear?

A

broken fragmented cells - HW disease, DIC, & splenic disease

53
Q

what do heinz bodies on a blood smear indicate? what are the agents that cause these in dogs & cats?

A

oxidative damage to RBC

dogs - onions
cats - acetaminophin

54
Q

what do echinocytes on a blood smear of an anemic patient indicate?

A

snake bite envenomation

55
Q

what does basophilic stippling on a blood smear of an anemic patient indicate?

A

lead toxicity

56
Q

what do nucleated RBCs on a blood smear of an anemic patient indicate?

A

regeneration, primary bone marrow disease, or splenic disease

57
Q

if positive, a saline agglutination test on an anemic patient is diagnostic for what disease?

A

immune-mediated hemolysis (IMHA)

58
Q

how do you perform a macroscopic agglutination test?

A

no microscope required - mix saline & blood on a slide and gently rock

look for clumping

59
Q

how do you perform a microscopic agglutination test? what disease process must you differentiate from agglutination in this test?

A

use a microscope! mix saline & blood & look for clumps

rouleaux

60
Q

spherocytes in a blood smear of an anemic patient is almost entirely pathognomonic for what disease?

A

IMHA

61
Q

microcytic, hypochromic anemia is almost entirely pathognomonic for what disease?

A

iron deficiency anemia - chronic external blood loss

microcytosis without anemia is not the same

62
Q

what 3 components of the urinalysis of the anemic patient are the most important to evaluate?

A
  1. pigmenturia
  2. urine specific gravity
  3. proteinuria
63
Q

what 3 kinds of pigmenturia can be seen in the anemic patient? what do they indicate?

A
  1. bilirubinemia - extravascular hemolysis
  2. hematuria - decreased platelets, thrombocytopathia (dysfunction)
  3. hemoglobinuria - intravascular hemolysis
    must differentiate from myoglobinuria - spin down urine to see if RBC will pellet
64
Q

if there is proteinuria present on the urinalysis of an anemic patient, what may this indicate?

A

infection or inflammation

65
Q

what may be seen on USG of an anemic patient?

A

inadequate concentration/isosthenuria - consistent with chronic kidney disease

66
Q

when you suspect a GI bleed, why do a fecal?

A

whipworms, hookworms - big culprits

67
Q

what are the pros & cons of VCE in a patient with a suspected GI bleed?

A

less invasive & may be able to see lesions in jejunum/ileum

weight cut off - can’t do in small dogs, & expensive

68
Q

what 3 tests should you run if you suspect there is an immune-mediated disease, such as IMHA or IMTP, leading to hemorrhage?

A

coombs’ test - looks for antigen-antibody complexes

flow cytometry for RBC or platelet surface antibodies

infectious disease testing - 4DX, babesia

69
Q

why would an abdominal ultrasound be helpful in working up an anemic patient?

A

better look at architecture - look for ulcers, masses, & intestinal wall thickening

70
Q

when would you consider an upper/lower gi endoscopy in an anemic patient?

A

bleeding ulcer - to confirm ulcer, biopsy, & neoplasia or zinc penny ingestion

71
Q

when are bone marrow exams indicated in anemic patients?

A
  • severe anemia not explained by chronic disease & non regenerative
  • > 5 days anemia & still non-regenerative
  • concurrent cytopenias with a non-regenerative anemia
72
Q

why does heart rate increase when O2 content is going down?

A

cardiac output = HR * stroke volume

cardiac output contains O2 content of RBCS, so the more that O2 drops, cardiac output increases to try & get oxygen to the body

73
Q

what are the transfusion guidelines for severe anemia of <18%?

A

often requires blood - can be case dependent as chronic severe anemias often are adjusted to their low RBC

74
Q

what are the transfusion guidelines for Hct or PCV <12%?

A

definitely requires transfusion - need to consider if the animal has been transfused before

need to also consider mechanism of deficiency

75
Q

what blood product is best for treating VWF?

A

cryoprecipitate

76
Q

what blood product should be used for hemorrhage or potentially clotting factor problems?

A
  • whole blood or plasma is the most appropriate with fresh whole blood being associated with better survival
77
Q

what blood product should be used for hemolysis or decreased production?

A
  • packed red blood cells are the most appropriate, less volume required & less immunogenic
78
Q

if a dog has been transfused before, you must what?

A

cross match!!!

79
Q

why is it important to blood type & cross match cats that need a blood transfusion?

A

type b has a strong reaction to type a causing a hemolytic anemia

80
Q

for every 1 ml/kg of pRBC, PCV will increase by how much?

A

1%

81
Q

if your pet is at 15%, using pRBC to raise PCV by 8-10% for a 10kg dog would be what?

A

80-100 mls of pRBC

82
Q

what is the difference between using pRBC & whole blood for a transfusion?

A

whole blood takes 2x the amount than pRBC - so for every 2 ml/kg of product, PCV raises by 1%

83
Q

if your pet is at 15%, using whole blood to raise PCV by 8-10% for a 10kg dog would be what?

A

180-200 mls whole blood needed

84
Q

what are some contraindications to pursuing a blood transfusion?

A

not cross matching to any units

severe heart disease - although, sometimes life & death, so go very very slow

85
Q

what is the ‘standard transfusion’ reaction? what should you do? what are some other complications?

A

increased temp - slow down the fluid rate

transfusion related acute lung injury & transfusion associated circulatory overload

86
Q

for a normovolemic patient, what is the transfusion rate?

A

10 ml/hr

87
Q

for a hypovolemic patient, what is the transfusion rate?

A

30 ml/hr

88
Q

for a patient at a high risk of overload (cardiac disease), what is the transfusion rate?

A

ideally no more than 5 ml/hr

89
Q

what is the recommended start in regards to rate for all transfusion patients?

A

can always start at 1/2 the recommended rate for the first 1/2 hour then increase

90
Q

what monitoring should be used for transfusion patients?

A

monitor HR & temperature every 5 minutes for the first 30 minutes & then span out to every 15 minutes for the remainder of the transfusion

SA DX & TX I (59 decks)

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