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Internal medicine (small) > Haematology (Yr 3) > Flashcards

Haematology (Yr 3) Flashcards

1
Q

what is anaemia?

A

reduction of RBC mass below the reference values for PCV, RBC count or total Hb

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2
Q

what are the three pathophysiological causes of anaemia?

A

inadequate production by bone marrow
increased destruction
loss (haemorrhage)

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3
Q

what type of anaemia is usually seen with inadequate production by bone marrow?

A

non-regenerative
normocytic normochromic

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4
Q

what type of anaemia is usually seen with increased destruction of RBCs?

A

regenerative
microcytic hypochromic

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5
Q

what type of anaemia is usually seen due to haemorrhage?

A

not regenerative enough
microcytic hypochromic
(hypoprotainaemia also seen)

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6
Q

how does the body respond to anaemia?

A

2,3-DPG increases in erythrocytes to give a lower oxygen-Hb affinity to allow better delivery to peripheral tissues
altering tissue perfusion
erythropoietin stimulates erythropoiesis
alterations to behaviour

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7
Q

what are some clinical signs seen with anaemia?

A

pallor
weakness
exercise intolerance
tachycardia/tachypnoea
haemic murmur

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8
Q

what are some possible findings on clinical examination of an animal with anaemia?

A

pallor
weakness
tachycardia/tachypnoea/dyspnoea
haemic murmur
icterus
petechiation
evidence of bleeding
pyrexia
lymphadenopathy
abdominal pain/mass or splenomegaly

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9
Q

what are the ways anaemia can be classified?

A

severity (mild/moderate/severe)
erythrocyte index (MCV, MCHC)
regenerative response

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10
Q

what is mild anaemia in dogs and cats?

A

30-36% dogs
20-24% cats

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11
Q

what is moderate anaemia in cats and dogs?

A

18-29% dogs
15-19% cats

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12
Q

what is severe anaemia in cats and dogs?

A

<18% dogs
<15% cats

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13
Q

what is MCV?

A

mean corpuscular volume (size of RBC)

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14
Q

what is MCHC?

A

mean corpuscular haemoglobin concentration (colour of RBC)

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15
Q

how can MCV of an RBC be described?

A

microcytic
normocytic
macrocytic

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16
Q

how can MCHC of an RBC be described?

A

hypochromic
normochromic

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17
Q

how are polychromatophils stained?

A

diff quik

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18
Q

how are reticulocytes stained?

A

new methylene blue

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19
Q

what are two classic signs on haematology of regenerative anaemia?

A

reticulocytosis
polychromasia

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20
Q

why do anaemias appear non-regenerative initially?

A

it takes 2-3 days for the reticulocyte count to increase

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21
Q

is the percentage reticulocyte count of absolute reticulocyte count more accurate?

A

absolute

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22
Q

what are the main causes of regenerative anaemia?

A

haemolysis
haemorrhage

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23
Q

what are the two types of immature reticulocyte?

A

aggregate (24 hours)
punctate (up to 10 days)

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24
Q

what causes hypovolaemic shock?

A

acute haemorrhage of all blood components

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25
Q

why will PCV and TP continue to fall even after acute haemorrhage has been stopped?

A

interstitial fluid moves into the vascular space so replace the lost blood volume, diluting the proteins nd RBCs

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26
Q

what is chronic blood loss?

A

continuous bleeding for >2 weeks

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27
Q

what type of anaemia can develop in cases of chronic blood loss?

A

iron deficiency anaemia

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28
Q

how regenerative is anaemia causes by chronic bleeding and iron deficiency?

A

initially is regenerative, will because less and less as the iron stones are used up

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29
Q

what is the appearance of RBCs in cases of iron deficiency anaemia?

A

microcytic hypochromic

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30
Q

what are some possible causes of iron deficiency anaemia?

A

chronic GI bleeding (most common) - NSAIDs, ulcers, neoplasia
parasite infections
congenital haemostatic defects
dietary is rare

31
Q

how is iron deficiency anaemia treated?

A

treat underlying cause
iron supplementation (oral ferrous sulphate)
blood transfusion

32
Q

why should you be cautious when using iron dextrans IM injection to treat iron deficiency anaemia?

A

can cause anaphylaxis
(is also painful)

33
Q

what are the two main categories of haemolysis?

A

immune mediated
non immune mediated

34
Q

what are some non immune mediated causes of haemolysis?

A

oxidative damage (onions, paracetamol, zinc)
intra-erythrocytic parasites
mechanical damage (angiopathic anaemia)

35
Q

what happens during extravascular haemolysis?

A

antibody binds to RBC
macrophages recognise RBC
phagocytosis/lysis of RBC
haem converted to bilirubin
bilirubin is conjugated in the liver

36
Q

how do spherocytes form?

A

from partial phagocytosis of RBCs

37
Q

what happens is the livers capacity for conjugating bilirubin is overwhelmed?

A

hyperbilirubinaemia leading to bilrubinuria and jaundice

38
Q

what happens during intravascular haemolysis of RBCs?

A

intravascular cell lysis
complement is activated\
haemoglobinaemia leading to haemoglobinuria and renal compromise

39
Q

why does intravascular haemolysis cause renal compromise?

A

the free haemoglobin leads to damage to tubular epithelium

40
Q

what are the possible clinical signs of intravascular haemolysis?

A

severe illness/sudden onset
pallor
collapse
jaundice
tachycardia/tachypnoea
splenomegaly
haemoglobinuria

41
Q

what are the signs on haematology of immune mediated haemolytic anaemia?

A

usually regenerative
autoagglutination
spherocytes
leukocytosis with left shift

42
Q

what test can be used to diagnose IMHA?

A

Coombs

43
Q

what is the Coombs test?

A

confirms the presence of anti-RBC antibodies by causing agglutination of the RBCs if they have anti-RBC antibodies on them

44
Q

how do macrophages cause spherocytes to form?

A

partial phagocytosis leads to decreased RBC surface forming a discoid shape

45
Q

where should spherocytes be looked for on a smear?

A

in the monolayer (this is where you should look at RBC morphology)

46
Q

what could cause autoagglutination of RBCs?

A

antierythrocyte IgM (or very high IgG)

47
Q

what is the difference between agglutination and rouleaux formation?

A

agglutination is antibody mediated clumping that is strongly supportive of IMHA
rouleaux formation is stacking of RBCs due to increased plasma proteins coating RBCs, caused by inflammation or cancer (normal in cats)

48
Q

how can you determine if a structure is a rouleaux formation or autoagglutination?

A

add saline to a drop of anti coagulated blood, the rouleaux formations will disappear

49
Q

what changes will be seen on biochemistry in IMHA cases?

A

elevated ALT and ALP
hyperbilirubinaemia
possible azotaemia

50
Q

what changes will be seen on urinalysis of IMHA cases?

A

haemolgobinuria
bilirubinuria
proteinuria

51
Q

what needs to be done before starting treatment for IMHA?

A

complete all diagnostic tests (immunosuppressants can mask underlying causes)

52
Q

what does IMHA treatment involve?

A

immuno-suppressive therapy
antithrombotic therapy
supportive therapy

53
Q

what would be the first choice drug for immunosuppressive therapy in IMHA?

A

prednisolone

54
Q

what are some side effects of corticosteroids?

A

PU/PD, polyphagia
muscle wastage
GI signs - gastritis, ulceration

55
Q

when would you consider using a second immunosuppressant in IMHA cases?

A

if clinical features of life threatening disease
no response to corticosteroids over first 7 days
if patient is at risk of severe side effects

56
Q

what is a salvage therapy for IMHA if immunosuppressants don’t work?

A

immunoglobulins (human IVIG) that block macrophage receptors

57
Q

how long are IMHA animals typically on immunosuppressants?

A

4-8 months

58
Q

what can be used as antithrombotic therapy for IMHA cases?

A

antiplatlet drugs - clopidogrel
anticoagulants - heparin

59
Q

what are some supportive therapies used for IMHA treatment?

A

blood transfusion
gastroprotectants (omeprazole) if evidence of GI bleeding/ulcers

60
Q

what is neonatal isoerythrolysis?

A

destruction of neonates RBCs by maternal antibodies from colostrum

61
Q

what is microangiopathic haemolytic anaemia?

A

RBCs get mechanically damage as they pass through fibrin meshwork in the microvasculature, these damaged cells are then removed rapidly from circulation

62
Q

what are some possible causes of microangiopathic anaemia?

A

altered vasculature (haemangiosarcoma…)
fibrin nets (DIC)
glomerulonephritis
congenital cardiac defects

63
Q

what are schistocytes?

A

fragmented RBCs

64
Q

what are some possible causes of acanthocytes?

A

liver disease (hepatic lipidosis)
splenic haemangiosarcoma
lymphoma
high cholesterol diets

65
Q

what can cause oxidative injury to RBC?

A

paracetamol - cats
onions, zinc - dogs

66
Q

why does oxidative injury to RBCs cause anaemia?

A

RBCs become more fragile so undergo haemolysis or are phagocytosed more readily

67
Q

what cell morphology is seen with oxidative damage to RBCs?

A

heinz bodies

68
Q

what are Heinz bodies?

A

round pale inclusions on the inner surface of RBC membrane due to denatured haemoglobin

69
Q

what animals is it normal to see some Heinz bodies in?

A

cats

70
Q

what is used to treat paracetamol poisoning in cats?

A

N-acetyl cysteine

71
Q

what type of anaemia is seen with Mycoplasma haemofelis?

A

regenerative

72
Q

how is Mycoplasma haemofelis treated?

A

doxycycline and prednisolone
(cats will remain carriers)

73
Q

what can cause a non-regenerative anaemia?

A

primary/secondary marrow disease
lack of erythropoietin (kidney disease)

74
Q
A

Internal medicine (small) (33 decks)

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