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FA2 Clinical Pathology > Lecture 3 8/29/24 > Flashcards

Lecture 3 8/29/24 Flashcards

1
Q

What are the characteristics of immune-mediated hemolytic anemia?

A

-autoantibodies are produced against patient’s own RBCs
-antibody binding to RBCs signals them to be phagocytized and broken down within macrophages
-antibody can potentially activate complement and cause RBC lysis in the bloodstream

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2
Q

Which type of hemolysis always occurs in IMHA?

A

extravascular

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3
Q

What laboratory changes can be present in a patient with IMHA?

A

-regenerative anemia
-spherocytes
-agglutination
-hyperbilirubinemia
-inflammatory leukogram
-hemoglobinemia
-hemoglobinuria

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4
Q

Which laboratory changes are specific for IMHA?

A

-spherocytes
-agglutination

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5
Q

What are the confirmatory tests for IMHA?

A

-saline dispersion test
-evaluation for RBC-bound antibodies

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6
Q

What are the characteristics of oxidant hemolytic anemia?

A

-RBCs are prone to oxidant injury due to carrying oxygen
-oxidant injury can lead to cellular damage or dysfunction if oxidant injury overwhelms antioxidant metabolic pathways

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7
Q

What are the possible manifestations of cellular damage/dysfunction caused by oxidative damage?

A

-methemoglobinemia
-heinz body formation
-eccentrocyte formation

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8
Q

What is the mechanism behind methemoglobin and the associated consequences?

A

mechanism: iron in hemoglobin is oxidized from Fe2+ to Fe3+
consequences: Fe3+ cannot bind oxygen, leading to poor oxygenation

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9
Q

What is the mechanism behind heinz bodies and the associated consequences?

A

mechanism: oxidation and precipitation of HGB globin proteins into pale pink inclusions
consequences: heinz bodies bind antibodies, promoting RBC death through extravascular hemolysis and resulting in anemia

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10
Q

What is the mechanism behind eccentrocytes and the associated consequences?

A

mechanism: oxidation of membrane components causing an area of membrane to adhere into a clear crescent
consequences: eccentrocytes have reduced deformability, promoting RBC death and resulting in anemia

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11
Q

What are the laboratory changes that can be seen with oxidant hemolytic anemia?

A

-pre-regenerative or regenerative anemia
-heinz bodies and/or eccentrocytes
-increased methemoglobin
-hyperbilirubinemia
-hemoglobinemia
-hemoglobinuria

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12
Q

Which pro-oxidants can cause oxidant hemolytic anemia upon ingestion?

A

-onions and garlic
-acetaminophen
-zinc
-wilted red maple
-copper

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13
Q

What is unique regarding cats and heinz bodies?

A

cats can have a few heinz bodies even in health

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14
Q

Which conditions can lead to the production of endogenous heinz bodies in cats?

A

-diabetic ketoacidosis
-lymphoma
-hyperthyroidism

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15
Q

Which RBC parasites commonly cause hemolytic anemia?

A

-Cytauxzoon felis
-hemotropic Mycoplasma spp.
-Anaplasma marginale
-Babesia spp.

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16
Q

Which mechanisms are possible in parasitic anemia?

A

-extravascular hemolysis
-intravascular hemolysis
-secondary IMHA
-anemia of inflammation

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17
Q

What are the laboratory changes that can be seen with parasitic anemia?

A

-pre-regenerative or regenerative anemia
-microscopic ID of RBC parasites
-hyperbilirubinemia
-hemoglobinemia
-hemoglobinuria

18
Q

What are the two main mechanisms non-regenerative anemia?

A

-erythroid hypoplasia
-ineffective erythropoiesis

19
Q

What are the characteristics of erythroid hypoplasia?

A

-decreased numbers of erythroid precursors in marrow
-indicates suppressed erythropoiesis
-occurs in disorders such as anemia of inflammation and anemia of CKD

20
Q

What are the characteristics of ineffective erythropoiesis?

A

-intramedullary death of erythroid precursors
-marrow tries to produce RBCs but they die prior to maturation into reticulocytes
-occurs in disorders such as precursor-directed immune mediated anemia

21
Q

What are the characteristics of anemia of inflammation?

A

-common cause of non-regenerative anemia
-can develop in any disease that leads to inflammatory cytokine release

22
Q

What is iron sequestration?

A

component of anemia of inflammation mechanism in which inflammatory cytokines trap iron within its storage sites

23
Q

What are the consequences of iron sequestration?

A

-total body iron stores are adequate, but decreased amounts are available for hemoglobin production
-causes a mild form of iron deficiency

24
Q

What are the expected CBC results for a patient with anemia of inflammation?

A

-mild to moderate
-non-regenerative
-normocytic
-normochromic
-decreased CHr

25
Q

What is the most common cause of a mild to moderate, normocytic, normochromic, non-regenerative anemia?

A

anemia of inflammation

26
Q

What are the mechanisms for anemia of CKD?

A

-decreased renal production of erythropoietin, resulting in erythroid hypoplasia in marrow
-chronic GI bleeding, resulting in absolute iron deficiency

27
Q

What are the expected CBC findings in a patient with anemia of CKD?

A

-mild to moderate
-normocytic
-normochromic
-non-regenerative
-normal CHr

28
Q

How can the typical anemia of CKD CBC results change if the patient has chronic GI hemorrhage and absolute iron deficiency?

A

-microcytic
-hypochromic
-decreased CHr

29
Q

How is anemia of inflammation distinguished from anemia of CKD?

A

-evaluation of clinical signs of CKD and/or inflammation
-evaluation of plasma chemistry and urinalysis results

30
Q

How does classic IMHA differ from PIMA?

A

-classic IMHA targets and destroys mature RBCs in circulation
-PIMA targets and destroys erythroid precursors in the bone marrow

31
Q

What are the expected CBC findings in PIMA?

A

-moderate to marked
-normocytic
-normochromic
-non-regenerative anemia
-often no spherocytes or agglutination

32
Q

What are the expected marrow findings in PIMA?

A

-ineffective erythropoiesis
-macrophages phagocytizing erythroid precursors

33
Q

What are the characteristics of FeLV and the blood?

A

-virus can affect hematologic cells in various ways
-virus can cause a very wide range of hematologic abnormalities of RBCs, WBCs, and/or platelets

34
Q

What are the characteristics of relative erythrocytosis?

A

-more common
-total mass of RBCs in the body has not changed
-occurs due to decreased vascular water or release of pooled RBCs from spleen

35
Q

What are the characteristics of absolute erythrocytosis?

A

-less common
-total mass of RBCs in the body is increased
-occurs due to increased RBC production by marrow

36
Q

How does dehydration cause relative erythrocytosis?

A

decreased plasma water concentrates RBCs in blood

37
Q

How does epinephrine cause relative erythrocytosis?

A

splenic contraction releases RBCs pooled in the spleen

38
Q

How does endotoxemia cause relative erythrocytosis?

A

damages endothelial cells, allowing plasma water to leak into extravascular space

39
Q

How does chronic hypoxia cause absolute erythrocytosis?

A

stimulates increased EPO production by kidneys

40
Q

How does inappropriate EPO production cause absolute erythrocytosis?

A

unregulated production of EPO by certain tumor cells

41
Q

How does primary erythrocytosis cause absolute erythrocytosis?

A

neoplastic proliferation of erythroid precursors that is independent of EPO

FA2 Clinical Pathology (21 decks)

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