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Hematology - Anemia Flashcards

1
Q

What is anemia?

A

Decrease in circulating RBC mass expressed by reduction in RBC count, hemoglobin, and Hct (PCV)

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2
Q

What is anemia caused by?

A

Decreased production, increased destruction, and increased loss

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3
Q

What are clinical signs of anemia due to?

A

Decreased O2 carrying capacity, reduced blood volume, and underlying disease

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4
Q

What do the severity of anemia signs depend on?

A

Rapidity of onset, degree and cause of anemia, and extent of physical activity

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5
Q

What is the normal response to anemia?

A

Accelerated erythropoiesis

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6
Q

How does accelerated erythropoiesis occur?

A

There is reduced oxygen carrying capacity which results in renal hypoxia. Renal hypoxia stimulates erythropoietin (EPO) release

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7
Q

After acute blood loss, dogs increase RBC production to __ to ___ times the normal rate.

A

6 to 8 times

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8
Q

After acute blood loss, cats increase RBC procution _ to _ fold.

A

3 to 5

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9
Q

What is the most useful marker of regeneration?

A

increased number of reticulocytes

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10
Q

What are reticulocytes?

A

immature non-nucleated erythrocytes

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11
Q

How long does it take reticulocytosis to develop? When does it peak? When does it decline in dogs? Cats?

A

Takes 2 to 4 days to develop.
Peaks between 4 and 7 days.
Declines at 2-3 weeks in dogs.
Declines in 9-13 days in cats.

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12
Q

What type of reticulocytes do cats have?

A

Aggregate and punctate

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13
Q

Which feline reticulocyte is present in the circulation for longer?

A

punctate

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14
Q

Which feline reticulocyte is counted in the laboratory reticulocyte count?

A

Aggregate

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15
Q

What is the reticulocyte percentage?

A

The percentage of RBC that are reticulocytes

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16
Q

What reticulocyte percentage indicates regenerative anemia in dogs? Cats?

A

0-1.0% in dogs, 0-0.4% in cats

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17
Q

How do you calculate the absolute reticulocyte count?

A

RBC count x RP

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18
Q

At what number of reticulocytes is considered to be a sign of regenerative anemia in dogs?

A

> 80,000 reticulocytes

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19
Q

At what number of reticulocytes is considered to be a sign of regenerative anemia in cats?

A

> 50,000 reticulocytes

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20
Q

True or False: Reticuocytes are the only absolute thing that you can use to determine if a patient has regnerative anemia.

A

TRUE

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21
Q

What are some other indicators of regeneration?

A

Increased MCV (macrocytic), increased RDW, decreased MCHC (hypochromic), polychromasia, and Howell-Jolly bodies

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22
Q

What is the hallmark of external blood loss? (Hint: it is a triad)

A

Anemia, hypoproteinemia, and reticulocytosis

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23
Q

What are some signs of a primary hemostatic defect?

A

Petechiae, ecchymoses, hematuria, melena, and epistaxis

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24
Q

What are some signs of a secondary hemostatic defect?

A

Hemoabdomen, hemothorax, hematomas, and joint bleeding

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25
What factors can be measured to determine if there is a primary hemostatic defect?
Platelet count and von Willebrand factor (vWF)
26
What tests can be done to determine if there is a secondary hemostatic defect?
Coagulation times - PT and aPTT
27
Are there any clues on the CBC of acute bleed anemia?
Shistocytes (DIC and hemangiosarcoma) and possibly decreased platelets
28
Below what number of platelets are patients at risk for spontaneous bleeding?
below 30,000 platelets/microliter
29
If the cause of acute (regenerative) anemia is not obvious, what other diagnostics can be done? What should not be done?
Radiographs, ultrasound, and endoscopy | Bone Marrow evaluation is not indicated for a regenerative anemia
30
How much is the canine blood volume?
90 ml/kg - it is 8-10% of body weight
31
How much is the feline blood volume?
60 ml/kg - it is 6-8% of body weight
32
When hemorrhage is greater than 20% of blood volume, what signs occur?
cardiovascular signs
33
Initially, what clinical signs are present in acute blood loss anemia?
Peripheral vasoconstriction and tachycardia
34
Why is regional blood flow to the skin and spleen curtailed during early stages of acute blood loss anemia?
To protect perfusion to the brain, heart, and viscera
35
What occurs when blood loss is greater than 30-40% of the blood volume?
CO decreases, hypotension with cardiovascular collapse, the animal is immobile with rapid/thready pulse, and the skin and extremities are cold
36
What occurs when blood loss is greater than 50% of the total blood volume?
Shock and death occurs within hours
37
True or False: Initially PCV and total protein are decreased in cases of acute blood loss anemia.
False - initially PCV and total protein are normal
38
When do PCV and TP decrease in acute blood loss anemia and why?
2-3 hours after the onset of bleeding, and continuing for 48-72 hours, blood volume replacement occurs by the addition of interstitial fluid
39
When will total protein begin to rise after an acute bleed?
2-3 days after a beed
40
Will TP or HCT normalize first after an acute bleed?
TP
41
When does a CBC return to normal after an acute bleed?
in about 2 weeks
42
If you have reticulocytosis for more than 2-3 weeks, what should you suspect?
There is an ongoing bleed
43
Initially, acute blood loss is of what type? (think about MCV, MCHC)
Normocytic, normochromic, and non-regenerative
44
When does acute blood loss anemia become macrocytic and regenerative?
After 3-4 days
45
What are the four main objectives to treating acute blood loss anemia?
Stop the bleeding and prevent future bleeding, replace the lost red cells, careful volume rescusitation, and treatment of underlying disorder
46
A healthy, normovolemic animal may tolerate a HCT of what percentage?
5-10% HCT
47
Signs of ______ develop much earlier in the hypovolemic, anemic animal.
hypoxia
48
Where is most iron located and in what form?
Most iron is located in RBC's as hemoglobin
49
Where does iron storage occur?
In the spleen, liver, and bone marrow
50
What is a major cause of iron deficiency anemia?
Chronic external blood loss
51
Initially iron deficiency anemia is regenerative/nonregenerative.
regenerative
52
What are some common causes of iron deficiency anemia?
Fleas, hookworms, bleeding GI neoplasia, Ulcerogenic drugs, and frequent phelobotomies
53
Pica can be found in patients with chronic blood loss anemia. Why?
Due to the iron deficiency
54
How does chronic blood loss anemia present?
Anemia, decreased Hgb synthesis, microcytes, hypochromasia, +/- thrombocytosis
55
True or False: Chronic blood loss anemia can be microcytic and hypochromic, or microcytic and normochromic.
TRUE
56
Why is there decreased Hgb in patients with chronic blood loss anemia?
because of the iron deficiency
57
What will you see on peripheral blood smear in patients with chronic blood loss anemia?
hypochromia, fragmentation (schistocytes), and keratocytes
58
If there is anemia with a high platelet count in patients with chronic blood loss anemia, what should you search for?
blood loss
59
What may a chemistry panel show in patients with chronic blood loss anemia?
low total protein
60
What chemistry change may be associated with GI blood loss?
Increased BUN
61
How do we treat chronic blood loss anemia?
Find and correct the underlying cause, correct anemia, correct iron deficiency, withdraw ulcerogenic drugs, control ecto- or endoparasites, surgical resction of tumor
62
When is a transfusion indicated in patients with chronic blood loss anemia?
With severe anemia or in preparation for anesthesia/surgery to find/correct GI hemorrhage
63
Patients with chornic blood loss anemia are _____volemic with an ______ cardiac output.
normo; increased
64
When is iron supplementation indicated?
Only in patients with iron deficiency anemia
65
What type of iron supplementation is recommended first in patients with iron deficient anemia?
Parenteral (IM iron dextran)
66
After using parenteral iron supplementation, how can iron be supplemented next?
Orally with ferrous sulfate
67
How do you treat patients with non-external blood loss anemias?
Autotransfusion - with resorption of approximately 80% of RBCs within 1-2 weeks
68
What is the normal RBC lifespan in the dog?
120 days
69
What is the normal RBC lifespan in the cat?
70 days
70
Hemolysis indicates shortened RBC lifespan due to what?
Intrinsic defect or an extrensic mechanism that leads to premature erythrocyte removal such as antibodies against erythrocytes
71
What type of hemolysis predominates in hemolytic anemia?
extravascular hemolysis
72
What does extravascular hemolysis refer to?
erythrophagocytosis in the spleen, liver, and bone marrow
73
What is extravascular hemolysis?
When RBCs are degraded within macrophages, so no Hgb is released from the cytoplasm
74
What is intravascular hemolysis?
When RBCs are lysed within the circulation as a result of membrane permeability changes or cellular fragmentation
75
Is hemoglobinuria and hemoglobinemia associated with extravascular or intravascular hemolysis?
intravascular
76
Is bilirubinemia and bilirubunuria associated with extravascular or intravascular hemolysis?
extravascular
77
Why does hemoglobinuria occur during intravascular hemolysis?
When the amount filtered through the kidneys exceeds the limited capacity of the tubule to resorb Hgb
78
What can cause artifactual hemolysis?
Poor venipuncture technique, prolonged blood storage, exposure to temperature extremes
79
What clinical signs are associated with hemolytic anemia?
Pallor, weakness, jaundice, pigmenturia - signs can be acute/fulminant or subacute/chronic
80
Is hemolytic anemia usually regenerative or nonregenerative?
regenerative
81
What is a common finding on CBC with patients with hemolytic anemia?
spherocytes +/- agglutination
82
What will you find on a chemistry panel in patients with hemolytic anemia?
Normal proteins and elevated bilirubin

Small Animal Medicine (100 decks)

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