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Clinical Medicine Master > Hematology and Anemia (MR) > Flashcards

Hematology and Anemia (MR) Flashcards

1
Q

Is anemia a disease?

A

NO, just a Cx

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2
Q

What is the proper progression of diagnostic testing?

A

PVC, CBC w/ Retic Count
+/- BM Aspiration or biopsy (bx)
+/- Advanced ClinPath Testing

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3
Q

Who can handle Anemia really well?

A

Cats!

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4
Q

Anemia grading for Dogs?

A

Mild (30 – 36%) Moderate (18 - 29%)

Severe (<18%)

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5
Q

Anemia grading for Cats?

A

Mild (20 – 24%) Moderate (15 - 19%)

Severe (<14%)

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6
Q

What about MCV and MCHC helps us to determine Regenerative vs Non-Regenerative?

A

Patterns within species that are associated with different conditions

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7
Q

What are rule outs for Regenerative Anemia?

A

Hemorrhage, Hemolysis

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8
Q

If Anemia is Regenerative what will MCV & MCHC tell me?

A

Macrocytic Hypochromic

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9
Q

What can it mean if you have Normocytic & Normochromic (Homogenous)?

A

Not Anemia or Anemia

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10
Q

If Normocytic & Normochromic but Anemic what are the possible causes?

A
  1. Non-regenerative 2º to Chronic Systemic Dz 2. 1º Bone Marrow Dz with failure of Erythropoisis
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11
Q

What are causes of Non-regenerative Anemia 2º to Chronic Systemic Dz?

A

Chronic Kidney Dz,Chronic Inflammatory Dz/Anemia of Chronic Dz - cytokines flying around inhibiting BM

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12
Q

Heterogenous look but still Normocytic Normochromic, what should you think?

A

Could be recent and regeneration has not really begun. Early Hemorrhage
Early Hemolysis
Chronic Hemorrhage
Early Fe Deficiency

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13
Q

Macrocytic & Normochromic is Regenerative or Non-regenerative? Caused by?

A

Regenerative - just not there yet. Caused by:Post-anemic period - Cats
Hyperthyroidism - Cats
Defective erythropoiesis - delayed nuclear maturation BM Dz

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14
Q

What are possible causes of Microcytic, Hypochromic?

A

Fe Deficiency Cu Deficiency

PSS – Puppies

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15
Q

What are possible causes of Microcytic, Normochromic?

A

PSS - Adult Dogs & Cats Healthy Akita Healthy Shiba Inu

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16
Q

When bloodwork doesnt make sense who should you be?

A

Skeptical Dog

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17
Q

If you dont have central palor in your red cells then what are they?

A

Spirocytes

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18
Q

If Anemia is regenerative and/or platelets are large is there any reason to biopsy BM?

A

NO, it is working. Hence, regeneration/large

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19
Q

What if you have a Normocytic, Norchromic, Non-regenerative Anemia with a Normal CBC, UA, no signs of Infection what should you do?

A

BM Aspirates/Biopsy

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20
Q

What is needed for BM core Biopsy?

A

General Anesthesia

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21
Q

How can you analyze BM?

A

Aspirates – Cytology. Biopsy (bx) – Histopathology

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22
Q

What can be evaluated by performing a BM Aspirate or Biopsy?

A

Precursors, Normal Development,
Maturation Process of all cell lines,
Abnormal Processes

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23
Q

Advanced Tests: What does Coombs test Dx? How?

A

Hemolysis & Agglutination from IMHA. Antiserum against Ab bound to RBCs

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24
Q

If agglutinating in tube, should you confirm dx with a Coombs test?

A

No, theyre agglutinating and that is the end result of the Coombs test.

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25
Q

Flow Cytometry detects what?

A

RBC Membrane bound Abs. MOST SENSITIVE!

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26
Q

Osmotic Fragility test detects what? Why is this test annoying?

A

RBC ↓ surface:volume ratio. RBC ↓ ability to Swell. Takes a long time and is very complicated

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27
Q

How regenerative is Anemia caused by Fe Deficiency?

A

Poorly

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28
Q

How regenerative is Anemia caused by Inflammation?

A

Not

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29
Q

How regenerative is Anemia caused by ↓ EPO/Kidney Dz?

A

Not

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30
Q

How regenerative is Anemia caused by Bone Marrow Damage?

A

Not

31
Q

How regenerative is anemia caused by Maturation defects in Bone Marrow (myelophthisis) - reduction of cell forming function of the Bone Marrow?

A

Not

32
Q

Which Hemolytic Anemias are caused by a ↓ in energy production? Which breeds are most likely to have this? (2)

A

HypophosphatemiaP. K Deficiency - Springer & Cocker Spaniels

33
Q

Which Hemolytic Anemias are caused by Infectious Dz? Is this 1º or 2º IMHA?

A

Hemoplasmas Babesiosis 2º

34
Q

Which Hemolytic Anemias are caused by Oxidative Damage?

A

Acetominophen Onions

35
Q

Which Hemolytic Anemias are caused by Fragmentation?

A

DIC

36
Q

Which Hemolytic Anemias are caused by Immune Mediated RBC Lysis? Which one is worse?

A

IgG TENDS to be - Extravascular Hemolysis/Phagocytosis. C3b tends to be - Intravascular Lysis. C3b - Complement is always worse - how body kills shit fast

37
Q

Why do we get shistocytes with 2º infectious IMHA?

A

Spleen macrophages try not to kill whole cell and just chomp out a bite! Silly spleen!

38
Q

Fe Deficiency Anemia in Neonates is due to? (3)

A

Low stores, Milk is low in Fe,

They are expanding their blood volume very quickly

39
Q

Fe Deficiency Anemia in Adults are due to? Where is this probably happening?When does it become evident?

A

Chronic Blood Loss out of the body, GI bleed, evident after Moderate to Severe depletion of Fe Stores

40
Q

In Fe Deficiency anemia what will RBCs look like? How regenerative is this?

A

Microcytic Hypochromic Target cells - Ton of Central Pallor
Poikilocytes
Poorly Regenerative

41
Q

What are the 2 most common and accessible Iron Assessment tests?

A

Serum iron on Chemistry, Stainable Fe in BM samples

42
Q

What causes non-regenerative Anemias? (2)

A

Acute Hemmorhage - no response of generation yet. ↓ Erythropoiesis 2º to Medullary Dz
Chronic Inflammatory Dz
Kidney Dz
BM Dz

43
Q

What causes ↓ EPO?

A

CKD, Inflammation

44
Q

What effect does inflammation have on erythropoiesis/RBCs? How?

A

↓ RBS Life Span ↓ EPO production
↓ Marrow Response to EPO
Fe Sequestration
: Cytokines, TNF, IL-2, IL-6, IFN

45
Q

What causes defective or ↓ Erythropoiesis?

A

↓ : Hemoglobin Synthesis, Nucleic Acid Synthesis,

Defective Maturation:

46
Q

What disease do neutrophils not mature past bands?

A

Pelger-Hewitt Abnormality

47
Q

Is IMHA regenerative or non-regenerative?

A

Highly Regenerative

48
Q

Which Immune Mediated failures of erythropoiesis are non-regenerative? (3)

A 
IMIE - IM Ineffective Erythropoiesis (attacking precursor cells), Pure Red Cell Aplasia,
Aplastic Anemia (aplastic pancytopenia) - kills all the baby cell precursors
49
Q

Which type of Immune Mediated Anemia would affect these cells?

A

PIC Aplastic Anemia

50
Q

Which type of Immune Mediated Anemia would affect these cells?

A

PIC Pure Red Cell Aplasia

51
Q

Which type of Immune Mediated Anemia would affect these cells?

A

PIC IMIE

52
Q

Which type of Immune Mediated Anemia would affect these cells?

A

PIC IMHA

53
Q

How many days do Neutrophils live? Platelets? Red Blood Cells?

A

N: 1,P: 1, RBC: 100

54
Q

How quickly does anemia develop with failure of erythropoiesis?

A

Slowly

55
Q

How do Cx present for anemia with failure of erythropoiesis?

A

Abruptly and Severely

56
Q

What will RBCs look like for MCV & NCHC?

A

Normo Normo

57
Q

Reticulocyte count?

A

Low Retic count

58
Q

What dzs are the result of FAILURE of erythropoiesis?

A

Aplastic Anemia, PRCA - Pure Red Cell Aplasia,

IMIE - IM Ineffectice Erythropoiesis

59
Q

Erythrocytosis: which type is most common? What causes this type? What other parameter will you most likely see with this type? What creature can have this and it is fairly normal for them?

A

Relative type is most common. Caused by: Dehydration/hemoconcentration
Other parameters: Total Proteins. Normal for: Sight Hounds

60
Q

What is Absolute Erythrocytosis? What is your PCV?

A

True ↑ in RBC mass. 70% - 80%

61
Q

What is 1º Erythrocytosis caused by? What type of Dz is this? What causes the erythrocytosis?

A

Caused by: Polycythemia rubra vera - tumor of red cell precursors. Type of Dz: Myeloproliferative - bone marrow pumpin out too many precursors. Erythrocytosis caused by: ↑ production of RBC precursors
VERY UNCOMMON SO RARE!

62
Q

What is 2º Erythrocytosis caused by?

A

↑ EPO

63
Q

What causes ↑ EPO?

A

Chronic tissue hypoxia (most common), Inappropriate EPO production

64
Q

What causes Chronic Tissue Hypoxia which can lead to ↑ EPO?

A

R-L Shunt Chronic Pulmonary Dz - Brachycephalic Dz
High altitude
Variant Hb

65
Q

What can cause Inappropriate EPO production which can lead to ↑ EPO?

A

Renal Issues: Tumors, cysts, pyelonephritis (local ischemia), Aberrant EPO production - neoplasia anywhere,
Endocrinopathies - hyperadrenocorticism, hyperthyroidism

66
Q

What are the consequences of Erythrocytosis?

A

↑ Blood Volume &/or Viscosity

67
Q

What are possible consequences of ↑ blood volume?

A

↑ CO, Chronically: CHF

68
Q

What are possible consequences of ↑ blood viscosity?

A

Poor tissue perfusion - too many red cells backing up in capillaries, Hemorrhage
Thrombosis
Cyanosis

69
Q

What is the study of blood flow?

A

Rheology

70
Q

What are the CX of Erythrocytosis?

A 
Generally related to the underlying cause considering most erythrocytosis are 2º.  Hyperemia
Splenomegaly
Neurological - seizures & ataxia
PU/PD
Microcytosis - Fe Deficiency
71
Q

What is the dz of blue-eyed dilutes where they have large granules?

A

Chédiak-Higashi Syndrome - BM abnormality in WBC precursors

72
Q

Tx of Erythrocytosis?

A

Tx Underlying Dz: Phlebotomy - fluid replacement
Hydroxyurea - drug
Maintain high normal PCV

73
Q

Why would it be beneficial to maintian a high PCV with erythrocytosis?

A

Dont want to stimulate EPO

74
Q

What is long term survival like with 1º erythrocytosis?

A

Good :)

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