Lecture 2: RBC II: regenerative anemia Flashcards
What are some signs of anemia
Pale MM, increased CRT, lethargy, tachycardia, tachypnea, low grade arrhythmias
what are some differentials for anemia
- Loss
- Destruction
- Decreased production
what type of anemia is associated with loss
initially regenerative to non-regenerative
what type of anemia is associated with destruction of RBC’s
regenerative
what type of anemias associated with decreased RBC production
non-regenerative
what are some causes of destruction causing anemia
IMHA, oxidative damage, infections, environmental// biochemical, intrinsic RBC defects
are reticulocytes indicative or regenerative or non-regenerative anemia
regenerative
is reticulocyte higher or lower with regenerative anemia
higher- reticulocytosis
what are the mechanisms for regenerative anemia
- Blood loss
- Hemolysis/destruction
what are the analyzer findings: MCV, MCHC, and reticulocytes for regenerative anemia
- MCV: high (macrocytosis)
- MCHC: (Hypochromasia) decreased (bone marrow releasing younger cells, less Hgb)
- Reticulocytosis (not horses)
what are the blood smear findings with regenerative anemia
- Moderate to marked ansiocytosis
- Moderate to marked polychromasia
- Moderate to marked basophilic stippling (ruminants)
what are the blood smear findings of regenerative anemia in dogs and cats
- Anisocytosis
- Release of polychromatophils
- Metarubricytosis and HJ bodies
what are the regenerative anemia signs on blood smear for horses
- May see anisocytosis
- Do not release polychromatophils!
What are some signs of regenerative anemia on blood smear for cattle
- Ansiocytosis
- Release of polychromatophils
- Basophilic stippling
blood smear from dog or cat, what do you see and what indicative of
Polychromatophils, ansiocytosis
Regenerative anemia
blood smear from cattle, what do you see and what does it indicate
Basophilic stippling, polychromatophils, anisocytosis
Regenerative anemia
how does bone marrow respond/ what results seen on analyzer and blood film with regenerative anemia
- Reticulocytosis on CBC
- Elevated MCV
- Decreased MCHC
- Increased polychromatophils
- Basophilic stippling in ruminants
t or false metarubicytes/ nRBC’s are seen in healthy animals
false
t or f: increased nRBC’s/ metarubriocytes = regeneration
false
on analyzer nRBC’s are counted as __ therefore is common cause of false __
WBC’s, lymphocytosis
which of the following are nRBC’s vs lymphocytes
left: nRBC’s
Right: lymphocytes
what is the N:C ratio for nRBC’s vs lymphocytes
both high, but more cytoplasm in nRBC’s
what color is cytoplasm a for nRBC’s vs lymphocytes
nRBC’s: red/purple
Lymphocytes: blue
nRBC’s or lymphocytes: pyknotic nuclei
nRBC’s
NRBC’s or lymphocytes: heterogenous chromatin
lymphocytes
which has smooth vs irregular cell borders: nRBC’s and lymphocytes
nRBC’s: irregular cell borders
Lymphocytes: smooth cell borders
increased # nRBC’s in circulation= __
metarubricytosis
nRBC’s in circulation are characterized by __ vs___
appropriate vs inappropriate metarubricytosis
what is appropriate metarubricytosis
increased nRBC’s in circulation with evidence of regeneration—-> metarubricytosis + reticulocytosis
what is inappropriate metarubricytosis
- Endothelial cell damage
- Metarubricytosis with no other signs of regeneration
what are Howell jolly bodies
small pieces of non-function nucleus
t or f: Howell jolly bodies= regeneration
false, can see increased numbers with regeneration but does not = regeneration
what circled
Howell jolly bodies
What is the mechanism for regenerative anemia
- Tissue hypoxia stimulates erythropoietin production
- EPO stimulates RBC production in bone marrow
- Reticulocytosis in circulation
Identify 1-2, what do they indicate
- Polychromatophils
- NRBC
Indicate regeneration
what value do you always need from CBC analyzer to determine if regenerative
absolute reticulocyte count
what blood work finding do you also see with regenerative anemia from blood loss that can help you differentiate from hemolysis
hypoproteinemia
what is per-acute hemorrhage and what are analyzer findings (MCV MCHC, reticulocyte count)
before BM has had time to respond, within/before 3-5 days
Analyzer: normocytic, normochromic, retics within RI
what is acute hemorrhage and what are analyzer findings (MCV, MCHC, reticulocyte count). What is iron level
At least 3-5 days after, still has adequate iron levels
Analyzer: macrocytic, hypochromic, elevated retics
what is chronic hemorrhage, what are iron levels, what are analyzer findings (MCV, MCHC, reticulocyte count)
over several days to weeks, iron deficient
Analyzer: microcytic, hypochromic, retics within RI
case ex: 1yr, FS mixed breed dog, hx of exercise intolerance, lethargy, pale MM, tachycardia. Following is patients CBC. Characterize the erythron, what likely cause
- Low total protein
- Low hematocrit (anemic)
- MCV elevated: macrocytic
- MCHC: low- hypochromic
- Reticulocytes: high- regenerative
Erythron: macrocytic, hypochromic, regenerative anemia
Causes: blood loss, parasites
case ex: 3yr, M cocker spaniel, hx HBC 1 day ago, painful abdomen, excessive fluid in peritoneal cavity. Following is CBC. Characterize erythron and what is most likely cause
- Total protein- low
- Hematocrit: low- anemic
- MCV: normocytic
- MCHC: normochromic
- Reticulocytes: normal
Erythron: normocytic, normochromic, non-regenerative anemia
Most likely cause: external blood loss, too early for regenerative response
for regenerative anemia what is MCV and MCHC: high or low
MCV: elevated- macrocytic
MCHC: low- hypochromic
Extravascular or intravascular hemolysis: hyperbilirubinemia, bilirubinuria
extravascular
extravascular or intravascular hemolysis: hemoglobinuria, hemoglobinemia
intravascular
what is total protein with intra and extravascular hemolysis
normal, can differentiate from blood loss anemia
what cells/ blood smear changes may you see with hemolytic anemia
spherocytes, eccentricities, Heinz bodies, ghost cells
where does extravascular hemolysis occur
outside vasculature, destruction occurs in macrophages near venous sinuses in spleen, liver and bone marrow
what pokilocyte is associated with extravascular hemolysis
spherocyte
what is pathogenesis of extravascular hemolytic anemia
- Macrophages convert HBG
2.Unconjugated bilirubin - Liver can’t keep up
- Bilirubinemia that spills over
- Biliruibinuria
what poikilocytes are associated with intravascular hemolysis
Heinz bodies, eccentricities, ghost cells
what is hemoglobinemia and how does it affect plasma color
free Hgb in plasma/serum
Bright red discoloration of plasma
how does hemoglobinemia affect MCHC, MCH on CBC
artificially increased
what is the most common cause of hemolytic anemia in dogs
IMHA
Is IMHA extravascular or intravascular hemolysis
extravascular
what is most common cause of IMHA
idiopathic
what are the analyzer findings- MCV, MCHC with IMHA
- MCV: Macrocytic
- MCHC: hypochromic or falsely normal
what blood smear findings are consistent with IMHA
polychromasia (regenerative), spherocytes
what are arrows pointing at and what are these associated with
spherocytes
IMHA
how do you dx IMHA
- CBC findings- macrocytic and hypochromasia
- Blood smear- polychromatophils and spherocytes
- Saline agglutination
- Coomb’s test
what are some toxins that cause intravascular hemolytic anemia
acetaminophen, red maple leaf, onions and garlic, zinc, copper
Heinz bodies in cats are not considered significant unless >__% of RBC’s in cats
10%
what are some diseases that cause >10% of RBC’s to be Heinz bodies in cats
- DM
- Lymphoma
- Hyperthyroidism
case ex: 2yr old M Pomeranian hx sudden onset vomiting, lethargy, brown urine. Owners found pile of pennies in vomit. Pale MM, tachycardia, tachypnea. The following CBC was done. Interpret erythron and what likely cause
- Total protein- normal
- Hematocrit- low (anemia)
- MCV: macrocytic
- MCHC: hyper chromatic (lies)
- Reticulocyte count- normal
Erythron: macrocytic, hyperchomatic, non-regenerative anemia
Likely regenerative but too early
Intravascular hemolytic anemia due to zinc toxicity
how do pennies cause zinc toxicity
copper coating dissolved in acid in stomach and directly irritates erythrocytes
what are some infectious organism that cause hemolytic anemia
- Mycoplasma
- Babesia
- Theileria
- Anaplasma
what type of anemia does cytauxzoon cause
nonregenerative anemia
mycoplasma infect the __ of RBC
surface
what organism
mycoplasma
Cat- what organism
cytauxzoon delis (signet ring shape_
what spreads mycoplasma haemofelis
fleas
what type of anemia does mycoplasma haemofelis cause
regenerative hemolytic anemia
what is the most common infectious cause of hemolytic anemia in cats
mycoplasma haemofelis
mycoplasma haemofelis is etiologic agent for __
Feline infectious anemia
what spread cytauxzoon Felis
ticks
what type of anemia does cytauxzoon Felis cause
non-regenerative anemia
from greyhound what likely cause
Babesia canis (tear drops)
from pit bull what cause
Babesia Gibsoni (ring)
What are the two possible causes of equine piroplasmosis
- Theileria equi
- Babesia caballi
what organism
Anaplasma marginale
hemolytic anemia with RBC fragmentation is seen with what diseases
- DIC
- Heart failure
- Vasculitis
- Heart worms
- Neoplasms
case ex: 6yr old Gelding with exercise intolerance, anorexia, lethargy, pale MM, tachycardia and tachypnea. Following CBC was performed. Characterize erythron. Patients plasma was bright red. what is a likely cause
- Total protein- normal
- Hematocrit- low (anemia)
- MCV: macrocytic
- MCHC: hyper chromatic (lies)
- Do not release reticulocytes
Cause: intravascular hemolytic anemia- toxin/ red maple leaf
horse presents with exercise intolerance, brown MM, brown urine and the following blood smear was performed. What do you see in blood smear and what is likely cause
Blood smear: eccentrocytes
Cause: red maple leaf toxicity/ toxin causing intravascular hemolytic anemia
