Haemolymphatic Flashcards
what disease are associated with non-regenerative anaemia in the cat?
- Pre-regn anaemia
- recent haemorrhage
- reg anaemia where the bone marrow has yet to respond
- frequent sampling in critically ill patients - kidney disease
- CKD
- Acute on chronic kidney disease - Inflammatory disease
- IBD
- Systemic illness/inflammation
- pancreatitis - Infectious disease
- FIV
- FeLV
- FIP
- Cytauxzoon felis
- Haemotrophic mycoplasma
- Leishmania infantum
- E.canis
- Mycobacterium sp. - Bone Marrow disease
- Pure red cell aplasia
- non-regen, IM haemolytic anaemia
- Aplasitc anaemia
- myelodysplastic syndrome
- myelofibrosis
- melopthesis - Neoplasia
- lymphoma - Hepatic lipidosis
- Deficiency
- B12
- Iron - Toxicity
- Drug reactions
- chemo/radiation
- propylthiouracil
- methimazole
- albendazole
- erythropoiesis stimulating agents
- antibiotcs - idiosyncratc, dose/duration dependant anaemia - TMS chloramphenicol
Olson JFMS 2019
What are the main pathogenesis of non-regenerative anaemia in cats?
RBC lifespan =73d.
- Decreased or ineffective erythropoesis
i. reduced EPO production
- CKD/AKI
- neutralizing Abs against EPO secondary to erythropietsis stimulating agents.
ii. Ineffective erythropoiesis
- - nutruent deficiency - iron/B12
- cystokine abnormalitis - systemic inflam aka anaemia of chronic disease
- primary bone marrow disorders: pure red cell aplasia, non-regen, IMHA, aplastic anaemia, myelopthesis etc - Decreased RBC lifespan - usually associated with regen anaemias but can be seen with non-regen too.
i. oxidative damage - higher numbers of oxidizable sulfhydryl groups + lower intrinsic antioxidant capacity + lack N-acetyl transferase 2 => increased risk fo oxidative damage and subsequent removal.
- oxidative stress
- mechanical stress
- complement induced injury
- rearrangement of memberane phosphlipids
- contact with cationic proteisn from activated Neutrophils
- heinz bodies
- haemotrophic parasites
- hereditary RBC defects: membarn protein abnormalities, RBC enx deficiency, haemoglobinopathies, increased ostmotic ragility
ii. Increased activation of the reticuloendothelial system => removal of RBC sooner.
- Immune med disease
- infectious disease
inflam
- paraneoplastic disease
Olson JFMS 2019
What are potential causes of acanthocytes in cats?
- neoplasia
- Bone marrow disorder
- hepatic lipidosis/liver disease
- doxorubicin therapy
Olson JFMS 2019
what are potential causes of elliptocytes/ovalocytes in cats?
- myelofiboris
- iron deficiency
- hepatic lipidosis/liver disease
- doxorubicin therapy
Olson JFMS 2019
what are possible cause of schistocytes in cats?
- neopalsia
- liver disease
- haemophagocytic histocytic disease
- acquired dyserythropoesis
- iron deficiency
- DIC
- doxorubicin
Olson JFMS 2019
what are possible causes of haemophagocytosis in cats?
- histocytic disease
- MCT
- mycoplasma haemofelis
Olson JFMS 2019
What are possible causes of heinz bodies in cats?
- acetaminophen
- onions and similar
- benzocaine
- propofol
- methionine
- methelene blude
- propylene glycol
- phenazopyridine
- DM
- hyperT4
- lymphoma
- liver disease
- other
Olson JFMS 2019
what are possible causes of erythrophagocytosis on cytology of BM, spleen Ln or liver in a cat?
- IMHA
- histocytic disorder
- multiple myeloma
- MCT
lymphoma - acute myeloblastic leukaemia
leishmaniosis.
Olson JFMS 2019
How can you differentiate iron deficiency anaemia from anaemia of chronic disease in cats?
- RBC- microcytosis and hypchromasia are insensitive markers of iron deficiency
- reticulocyte HB content <0.88fmol has 93% sens and 76% spec for iron deficiency in cats.
- serum iron - low in both
- ferritin:
- low in iron deficiency
- increase in anaemia of inflammation - Transferrin, measured indirectly by total iron binding capacity
- normal to increased in iron deficiency
- lower with inflammation and if concurrent inflammation and iron deficiency, this can lower TIBC even if iron deficiency is present. - Iron saturation percentage <20% may be suggestive of iron deficiency
Olson JFMS 2019
what is the difference between:
- pure red cell aplasia
- non-reg IMHA
- Aplastic anaemia
- myelodysplastic sytndrome
- secondary dysmyelopoiesis
- myelofibrosis
- myelopthesis
1. Pure red cell aplasia Blood smear: - normocytic normochromich non-regen anaemia - no other cytopenias Bone marrow: - decreased to absent RBC precursors
- non-reg IMHA
Blood smear:
- normocyti to mactocytic (secondary to agglutination)
+/- neturopenia/thrombocytopenia
+ at least 1 of the following:
- persistent agglutination following saline washing of RBCs
- positive direct antiglobulin test
- ghost cells
Bone marrow
- marked erythroid hyperplasia with low myeloid:erythroid ratio
+/- maturation arrest
+/- erythrophagocytosis
+/- dysplasia, fibrosis, necoriss and inflam
3. Aplastic anaemia Blood smear - bi to pancytopenia Bone marrow - marked reduction or absence of normal haemaotpoetic tissue, replaced with fat.
4. myelodysplastic sytndrome Blood smear - bi to pancytopenia \+/- macrocytosis Bone marrow - normo to hypercellular - blast cells (reubriblast or myeloblasts) < 30% of nucleated cells - dysplastic change in all 3 cell lines
5. secondary dysmyelopoiesis Blood smear - non-regen anaemai without macrocytosis Bone marrow - normal to increased cellularity with dysplastic changes most prominent in the red cell line
- myelofibrosis
Blood smear:
- reflects underlying cause (MDs, acute myelogenous leukaemia, non-regen IMHA, PRCA)
Bone marrow
- req histopath staining for an excess of reticulin fibrosis (usually absent in normal feline bone marrow) - myelopthesis (infiltration and replacement of BM by abnormal cells)
Blood smear:
- non-regen anaemia
+/- circ neoplastic cells
+/- variable cytopenia
Bone marrow:
- infiltration with neopalstic haemopoetic cells.
Olson JFMS 2019
Is the use of eyrthroid stimulating agents expected to be beneficial in pure red cell aplasia?
No as EPO is already increased
Olson JFMS 2019
What proportion of cats receiving Darbopoetin develop antiEPO antibodies? and for epoetin?
Darbopoetin - 8%
Epoetin - 25-45%
Olson JFMS 2019
which patients are most likely to develop hospital acquired anaemia?
- both dogs and cats but cats»_space;dogs
- patients that had more blood samples
- had surgery
- dogs were less likely to survive to discharge.
Lynch JVIM 2016
What are 3 markers of oxidative stress?
Which is altered in anaemia dogs?
- Glutathione peroxidase - decreased in anaemia
- plasma total antioxidant capacity - no change
- urinary F2 isoprostanes. - no change
Kendall JVIM 2017
What are Kai 1 and Kai 2?
Additional canine blood groups not related to DEA 1, 3, 4, 7 and Dal.
Euler JVIM 2016
What combination of Kai 1 and Kai2 are most dogs in the USA?
Kai 1+/Kai 2-
Euler JVIM 2016
What classes of antibodies are antiKai 1 and antiKai2 antibodies?
AntiKai 1 = IgM
AntiKai 2 = IgG
Euler JVIM 2016
do dogs negative for Kai1, Kai2 or both have naturally occuring alloantibodies?
no
Euler JVIM 2016
Which breeds in north america are most likely to be Dal -? What is the significance of this?
- Shih tzu (57.1%)
- Doberman (42%)
- Dalmations (11.7%)
this increases their risk of being sensitized by a blood transfusion from the common Dal + donor => extended Dal testing should be consideded in these breeds and in dgs with incompatibly blood after initial transfusions.
Goulet JVIM 2017
What is the prevalence of major cross match reactions in cats that were:
- transfusion naive
- previously cross matched
tansfusion anive - 15%
Previously transfused 27%
McClosky JVIM 2018
With what frequency do febrile transfusion reactions occur in cats which were:
- cross match prior
- not cross matched
Cross matached - 2.5%
not cross matched - 10%
McClosky JVIM 2018
When is a cross match recommended for cats? Why?
Before each transfusion - including the first due to the risk of non-AB/Mik alloantibodies resulting in transfusion reactions.
McCloskly JVIm 2018
What changes are expected to be seen in feline whole blood stored for 35 days?
- reduced WBC
- reduced PLT
- reduced normal RBC
- increased echinocytes
- increased lysed RBC
Spada JFMS 2019
What factors regarding RBC indices may change in dogs donating blood more than 6 times annually? What is this likely secondary to?
- lower PCV, HCT and retic count
- Retic indices: lower retic MCV, and retic Hb
- normal serum iron and ferritin but lower TIBC
Suggests iron deficiency erythropoiesis.
Foy JVIM 2015
Does Leukoreduction prior to storage of canine pRBC cause any changes?
All resolve during storage but initially:
- increased thromboxane B2 and prostaglanin T2alpha
doesn’t decrease the accumulation of 6-keto-PGF1alpha
Muro JVIM 2017
what percentage of DEA-1 matched recieviers become incompatible against other RBC antigens after matched transfusion in dogs?
44%
Goy-Thollot JVIM 2017
Does major cross matching transfusion naive cats prior to blood transfusion improve transfusion PCV stabilization?
no
Didn’t change efficacy or decreased adverse events assocaited with RBC transfusion in AB blood typed transfusion naive cats.
Sylvane JVIM 2017.
Can blood be collected from cats via a closed system?
yes - TEC 724 kit, Futurlab Srl)
1/8 at day 35 did have bacterial growth
Crestani JVIM 2017
Can weakly DEA 1+ blood be transferred to a DEA 1- recipient?
It should not be as this will cause alloimmunization in the DEA 1- recipient.
Guidetta JVIM 2019
When should dogs be blood typed?
When should it be cross matched?
Typed
- prior to any transfusion for DEA 1 to ensure appropriate matching
Cross match:
- after receiving any RBC products > 4 days before the next transfusion.
