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Hematopoietic disorders - Infectious causes of Anemia Flashcards

1
Q

Definition of anemia

A
  • absolute reduction in circulating red cell mass
  • Inadequate oxygen transport
  • Interference with organ function
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2
Q

History of anemia

A
  • Trauma
  • Dietary history
  • Parasite (Haemonchus)
  • Hemorrhage or other illness
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3
Q

Clinical presentation of anemia

A
  • Weakness
  • Depression
  • Lethargy
  • Dementia or disorientation
  • Exercise intolerance
  • Pale mucous membranes
  • Tachycardia
  • Tachypnea
  • Debilitation associated with chronicity
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4
Q

Where to check mucous membranes?

A
  • Conjunctiva

- Vulva

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5
Q

PE findings of canemia

A
  • Pallor
  • Icterus if RBC destruction (won’t happen as much with liver disease)
  • Fever
  • Systolic murmur
  • Signs of blood loss (epistaxis, melena, hematuria, hematochezia)
  • Edema from protein loss
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6
Q

Diagnosis of anemia

A
  • Decreased PCV or HCT
  • Decreased Hemoglobin
  • Decreased RBC count
  • Indices (MCV, MCHC) work well in ruminants
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7
Q

What does MCV represent?

A
  • Average RBC volume (Mean Cell Volume)
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8
Q

Increase in MCV

A
  • Regenerative anemia
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9
Q

Decrease in MCV

A
  • Fe and Cu deficiency

- Or healthy calves

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10
Q

MCHC meaning

A
  • Cellular hemoglobin concentration per average RBC

- Mean cell hemoglobin concentration

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11
Q

Meaning of a decreased MCHC

A
  • Fe deficiency anemia
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12
Q

Increased MCHC

A
  • Usually always false
  • Hemolyzed, icteric, or lipemic samples
  • Heinz bodies
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13
Q

What are the two main categories of anemias?

A
  • Regenerative

- Non-regenerative

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14
Q

How long for regenerative bone marrow response to occur?

A
  • 5-7 days
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15
Q

What are the two categories of regenerative anemias?

A
  • Hemorrhage (blood loss)

- RBC destruction

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16
Q

Non-regenerative anemia

A
  • Bone marrow doesn’t respond

- Inadequate erythropoiesis

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17
Q

What characterize regeneration in ruminants and camelids?

A
  • Reticulocytes and nucleated RBCs
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18
Q

How long for camelids to regenerate?

A
  • Can tkake months
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19
Q

Causes of acute blood loss

A
  • Epistaxis
  • Surgical procedures
  • Ruptured liver, spleen or lung
  • Large vessel bleed
  • Clotting defect
  • Gastric ulcer
  • Hemoperitoneum
  • Hemothorax
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20
Q

Signs of acute blood loss

A
  • Obvious source of loss (although might not see in deep chested ruminants, GI loss, or animals with omentum that can wall it off)
  • Hypovolemic shock (tachycardia, tachypnea, cold extremities, pale mm, muscle weakness, and death eventually
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21
Q

Diagnosis of acute blood loss a

A
  • Change in PCV/TP

- Hemoperitoneum and hemothorax (ultrasound, abdominocentesis, thoracocentesis)

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22
Q

Treatment for acute blood loss

A
  • Stop hemorrhage
  • Treat hypovolemic shock (shock rate with isotonic crystalloids +/- small volume hypertonic saline +/- whole blood transfusion)
  • Whole blood transfusion really only feasible in small ruminants and calves
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23
Q

At what % of total blood volume do you see signs of hemorrhagic shock?

A
  • 30%
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24
Q

What is total blood volume?

A
  • 8% total BW in kgs
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25
When do you start seeing signs of overt blood loss/anemia?
- 8% of blood volume
26
In a 500 kg Holstein: 1. What is total blood volume? 2. How much blood loss for signs of anemia? 3. how much blood loss for signs of hemorrhagic shock?
1. 40 L 2. 3.2 L for signs of anemia 3. 12 L for signs of hemorrhagic shock
27
Blood typing for whole blood transfusion
- High variability among blood groups and types amongst ruminant species - single transfusion is generally safe
28
Monitoring during whole blood transfusion
- Temperature - Urticaria - Vomiting - Dyspnea - Increased HR - Have banamine or diphenhydramine ready to give if signs of reaction
29
Chronic blood loss - when will you see clinical signs?
- PCV is <15% - Physiologic adaptation masks signs until then - Slow progression
30
Common causes of chronic blood loss (remember)
- Haemonchus - Bleeding GI lesions - Some renal disease - Hemostatic dysfunction - Blood sucking external parasites
31
Clinical signs of chronic blood loss
- Ill thrift - Poor body condition and hair - Pallor of MM - Edema if protein also chronically lost (albumin) - Weakness, lethargy
32
FAMACHA
- Aenmia guide for owners to get certified | - Trying to figure out when to do deworming
33
What are the two parts of hemostasis?
- Coagulation and fibrinolysis
34
Inherited coagulation disorders
- Rare | - Examples are hemophilia A and Factor XI deficiency (autosomal recessive)
35
Hemophilia A is a deficiency of what
Factor VIII deficiency
36
Acquired hemostatic disorder
- Sweet clover toxicosis
37
Which species of clover can lead to sweet clover toxicosis?
- Melilotus officinalis and M alba
38
What type of sweet clover leads to sweet clover toxicosis?
- Moldy sweet clover hay or silage containing dicoumarol
39
Which states have a problem with sweet clover toxicosis?
- Northern Plains States | - Includes Idaho and Montana
40
Pathogenesis of sweet clover toxicosis
- Coumarins in legumes and alfalfa converted by molds to dicoumarol - Same as warfarin toxicosis - Interferes with hepatic synthesis of clotting factors, II, VII, IX, and X by inhibiting Vitamin K - Need a certain amount of Dicoumarol over several weeks
41
Which clotting factors are impacted by moldy sweet clover toxicosis?
- II, VII, IX, and X | - By inhibiting vitamin K synthesis
42
Which pathways (intrinsic, extrinsic, common) are impacted by moldy sweet clover toxicosis?
- Intrinsic (IX) - Extrinsic (VII) - Common (X) - Also impacts prothrombin (factor II)
43
Signs of sweet clover toxicosis
- Stiffness and lameness (hemorrhage into joints) - Early signs include epistaxis and melena from dark, digested blood - Death by massive hemorrhage
44
Dfdx for sweet clover toxicosis
- DIC, Bracken Fern toxicosis, mycotoxicosis
45
Clin path for sweet clover toxicosis
- Prolonged PT and PTT - +/- Hematuria (not platelets, just clotting factors) - Normal platelet count to differentiate from DIC and bracken fern
46
How do you differentiate sweet clover toxicosis from DIC and bracken fern on CBC?
- Normal platelet count
47
Treatment for sweet clover toxicosis
- Vitamin K (4 weeks of high dose | - Whole blood transfusions for severe loss
48
Anaplasma that impacts cattle vs sheep
- A. marginale (cattle) | - A. ovis (sheep)
49
Vector for anaplasma
- Dermacentor species - Biing flies - Mechanical vectors
50
Transmission of Anaplasma
- Intrauterine | - Also mechanical vectors
51
Spread of Anaplasma
- In most states
52
Reservoir for Anaplasma
- Asymptomatic cattle | - Stressed carriers can break with disease
53
Time of year for Anaplasma?
- Late spring and summer
54
Incubation of Anaplasma? Primary exposure? At what % decrease in RBCs do you see clinical signs?
- Highly variable - acute severe to subclinical - 15-30 day incubation - Primary exposure at calfhood - Clinical signs seen when 35-50% decrease in RBCs - Peracute death
55
Acute signs of anaplasma
- Pyrexia (103-106°F) - Subsides in 12-24 hours - Subnormal at death due to hypovolemia - Anorexia, lethargy, drop in milk production - Signs of anemia - Mucous membranes pallor or icteric - +/- dark brown feces, pollakiuria - Abortion - DO NOT SEE HEMOGLOBINURIA****
56
Do you see hemoglobinuria with Anaplasma?
- NO - Extravascular hemolysis in Anaplasma - Intravascular hemolysis required for hemoglobinuria
57
Hemoglobinuria
- Plasma reflects a hemolytic state with icterus potential | - Deep red to black urine
58
Where is the discoloration in the urine with hemoglobinuria?
- Throughout urination
59
Hematuria
- blood in urine - Red, brown, or pink - RBCs seen on microscopic exam
60
Where can you localize hematuria if seen at beginning of urination?
- Urethra, repro tract
61
Where can you localize hematuria if seen at end of urination?
- Bladder
62
Where can you localize hematuria if seen throughout of urination?
- Kidney - Ureters - Differentiate from hemoglobinuria
63
Clinical signs of Anaplasma in sheep
- Typically subclinical
64
Clinical signs of Anaplasma in goats
- Rare, severe anemia
65
Clinical signs of Anaplasma in camelids
- rare anemia
66
Clin path of Anaplasma
- IDentify organism on a blood smear - Wright's stain, New methylene Blue, Giemsa stain - May see RBC regeneration chronically
67
Where will death occur for a rapid vs gradual PCV drop?
- <20% at rapid | - <10% at gradual drop
68
Diagnosis of Anaplasma
- Serology to ID persistently infected (difficult) - Competitive ELISA*** (high sensitivity and specificity; approved by USDA and OIE) - PCR (seroconversion in acute disease; confirm diagnosis in acute infection)
69
Which test for diagnosing Anaplasma is approved by USDA and OIE?
- competitive ELISA - High sensitivity and specificity - Looks for antibody
70
Treatment for Anaplasma
- Oxytetracycline in acute disease | - Supportive care if needed with whole blood transfusion
71
Will treatment for Anaplasma eliminate persistent infection?
- No
72
At what PCV will prognosis for Anaplasma be considered poor?
<8%
73
Prevention of Anaplasma
- Decrease transmission by getting rid of tick vectors | - In endemic areas with low transmission rates, there is some conditional vaccination
74
For prevention of Anaplasma in a herd free of it an a non-endemic area?
- Quarantine and serological screening
75
Babesiosis - is it reportable?
- YES
76
Babesia in the US
- Eradicated in the US
77
Organism involved in babesiosis?
- Babesia bovis | - Obligate intracellular parasite of RBCs
78
Transmission of Babesiosis?
- One-host tick - Rhipicephalus spp - Formerly Boophilus
79
Incubation of babesiosis
- 2-3 weeks
80
Clinical signs of babesiosis
- pyrexia (104-107.6°F) - Depression, icterus, anorexia - Aenamia with intravascular destruction of RBCs - Hemoglobiniemia - Hemoglobinuria*** - Abortion - Death - Cerebral babesiosis (low RBC, grave prognosis)
81
Clin path of babesiosis?
- Anemia with regeneration
82
Diagnosis of babesiosis?
- ID on Giemsa-stained blood smear in acute infections - Serology (IFA and ELISA) - PCR
83
Poor prognostic indicators for babesia
- <10% PCV and neuro signs
84
Treatment of Babesia
- Imidocarb - Diminazene - Phenamidine - Amicarbalide
85
Prevention of Babesia
- Tick vector eradication - Useful in US - Immunization
86
Hemobartonellosis cause
- Hemotropic mycoplasmas
87
Which Mycoplasma causes hemobartonellosis in camelids? ***
- Eperythrozoon sp (M. Haemolamae)
88
Which Mycoplasma causes hemobartonellosis in cattle?
E. wenyonii
89
Which Mycoplasma causes hemobartonellosis in sheep?
- E. ovis
90
Where is hemobartonellosis?
- world wide but generally minor disease
91
Who gets hemobartonellosis?
- Most often stressed animals - Younger more likely than old - Immunosuppression (e.g. splenectomy) - carrier animals
92
Transmission of hemobartonellosis
- Blood (insects, needles, castration) | - Intrauterine
93
How long do infections with hemobartonellosis last?
- Life long
94
Incubation period for Hemobartonellosis
1-3 weeks
95
Clinical signs of hemobartonellosis in cattle
- Rare clinical disease in cattle - Fever, stiff gait - < Milk production - udder edema - Diarrhea - Lymphadenopathy - prefemorals - Scrotal swelling - Swollen legs
96
Clinical signs of hemobartonellosis in sheep
- "yellow lamb disease" - Rare sudden death with hemoglobinuria and icterus - Less severe disease with fever, depression, anemia, and weight loss
97
Clinical signs of M. haemolamae (hemobartonellosis in camelids)
- Variable clinical signs: anemia, depression, fever, weight loss - Hypoglycemia is common in camelids
98
Mode of transmission of M. haemolamae
- Unknown - Biting insects - In utero transmission
99
Diagnosis of M. haemolamae
- PCR - Can also do a gram stain on a blood smear - Epicellular parasite on RBC - Anemia - CF, ELISA, PCR
100
What should a primary differential in a camelid with anemia be?
- M. haemolamae
101
Treatment for hemobartonellosis
- Oxytetracyclines - LA (brand) 200mg/mL (LA 200) - Up to 50 days - May not eliminate carrier state
102
Leptospirosis issues
- Zoonotic
103
Syndromes associated with Lepto
- late term abortion - Hemolytic anemia - Septicemia - mastitis - Combo
104
Etiology - which Leptospira serovars are responsible for majority of disease?
- Leptospira interrogans serovars Pomona and icterohemorrhagia
105
Clinical signs of hemolytic form of leptospirosis
- Young calves, lambs, kids, crias (adults??) - Incubation 3-7 days - Fever - Anorexia, depression - Petechiation - Hemoglobinuria**** - Anemia - Icterus - Tachycardia and sypnea - Death in 2-3 days Slow recovery
106
Clin Path for Leptospirosis
- Moderate leukocytosis - Hyperfibrinogenemia - Hemoglobinemia - Hemoglobinuria
107
Definitive diagnosis of leptospirosis
- Based on demonstration of organism in urine, milk or fetal tissues - MAT, PCR FAT
108
Treatment for Leptospirosis
- Oxytetracycline - Streptomycin - Procaine Pen-G - Supportive care
109
Prevention of leptospirosis
- Vaccination - Removal of carriers - Hygiene
110
What to do if you suspect leptospirosis?
- Go into isolation!
111
Bacillary hemoglobinuria
- Acute fatal clostridial disease | - Liver infarct, toxemia, intravascular hemolysis
112
Etiology of bacillary hemoglobinuria
- Clostridium novyi type D (C. hemolyticium)
113
Major toxin in bacillary hemoglobinuria
- Beta toxin - Phospholipase C - Causes hepatic necrosis, hemolysis, and damage to capillary endothelium
114
Timing of bacillary hemoglobinuria
- Summer and early fall
115
What events do bacillary hemoglobinuria outbreaks usually follow?
Flooding
116
Pathophysiology of bacillary hemoglobinuria
- Spores ingested by animal --> cross intestinal mucosa and transported to liver via mcarophages --> persist in Kupffer cells - Localized anaerobic areas promote germination (liver flukes) - Release of toxins --> increase anaerobic environment --> further bacteria growth and hepatic necrosis - Abrotpion of toxins leads to intravascular hemolysis, icterus, hemoglobinuria, and death
117
Clinical signs of bacillary hemoglobinuria
- Sudden death - Antemortem signs are uncommon - Depression, anorexia, fever, tachypnea - Rectal bleeding - Severe hemoglobinuria (port wine colored) - pale and icteric mucous membranes
118
Necropsy findings of bacillary hemoglobinuria
- Necrosis in the liver grossly | - Can do an impression smear
119
Clin path of bacillary hemoglobinuria
- rare to get BW and diagnostics antemortem - Anemia, high AST, and GGT, high bilirubin - Hemoglobinuria - FAT on impression smears of liver infarct - Area, history, clinical signs, and necropsy
120
Dfdx for bacillary hemoglobinuria
- Anthrax, lightning
121
Treatment for bacillary hemoglobinuria
- Grave prognosis - High dose penicillin or tetracycline - Supportive care could give blood transfusions
122
Prevention of bacillary hemoglobinuria
- Liver fluke control - Vaccination with commercial bacterin/toxoids - Highly effective but short immunity - Time with liver fluke season Destroy the carcasses
123
Infectious causes of anemia that have intravascular hemolysis
- Bacillary hemoglobinuria - Leptospirosis - babesiosis Hemobartonellosis

Ag Animal II (13 decks)

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