Lecture 6 - non regenerative anemias Flashcards
nonregenerative anemias __ are minimal or absent and is often has normal __ and __ values (except iwth deficiencies like iron)
polychromasia/reticulocytosis, MCV (normocytic) and MCHC (normochormic)
are clinical signs of anemia present with nonregenerative anemias
absent or mild
__ can cause selective depression of EPO which cuases BM activity reduction and RBC maturation defects
systemic dz outside the BM (extramarrow dz)
inadequate or abnormal hematopoiesis due to __ causes a reduction of all cell types
primary BM dz (intramarrow dz)
what non-regenerative anemia would you expect to see only anemia (only RBC decreased)
extramarrow/systemic dz
List the humoral factors that support RBC production in BM
- EPO (kidney)
- Iron (liver)
- endocrine hormones (pituitary, thyroid, glucocorticoids, androgens)
Do you need to collect a BM sample to dx cause of nonregenerative anemia?
NO, can rule out systemic dz (renal/liver dz, inflammation, extramarrow cancer, endocrine disorder)
patients with __ renal failure are anemic, while patients with __ renal failure are usually NOT anemic
Chronic (>100days), acute
blood smear findings with chronic renal dz nonregenerative anemia
mild to moderate, normocytic, normochromic, nonregenerative anemia. serum/urine chem changes consistent with renal dz
what is the MOST COMMON nonregenerative anemia of domestic animals
anemia of chronic inflammatory dz
__ released with inflammation make the BM nonresponsive to EPO
inflammatory cytokines
most __ have infalmmatory components
chronic dz
nonifections -IM, neoplastic, toxic or
infectious - bact, fungal, viral, protozoal
The clinical signs seen with anemia of inflammatory dz are caused by
underlying dz, NOT the anemia (anemia will improve when dz is treated)
Cytokines released during inflammation cause __ to be stored (not available to make RBC) which impairs BM repsonse to EPO and shortens RBC survival
iron
blood smear/lab findings with chronic inflammation nonreg anemia
- mild to mod, normocytic/chromic, nonregenerative anemia with LITTLE OR NO Poikilocytosis (abnormal shaped cells)
- chronic inflamm leukogram
- hyperglobulinemia (intravascular hemolysis)
- decrease in serum iron
__ is a protein that binds stored iron putting it on “lock down”, the stored iron is found in what organs. __ is a protein that carries iron around the body but this is decreased with inflammation nonreg anemia
ferritin, BM and spleen, transferrin
What anemia looks similar to iron deficiency anemia?
nonreg anemia of chronic inflammatory dz
chronic liver dz causes
functional iron deficiency due to transferrin protein not being made by liver = iron can’t be transported to the BM for RBC production. Have the Iron just can’t use it.
blood smear/lab findings with chronic liver dz nonreg anemia
- mild to moderate, normocytic, normochromic, nonregnerative anemia
- Poikelocyte = Acanthocytes (uneven spicules)
- . low MCV or MCHC occationally seen (due to Hgb:SA ratio)
- serum/urine biochem seen with liver dz.
Poikelocyte seen with non reg chronic liver dz anemia
acanthocytes
__ and __ are common endocrine def in older dogs and can cause endocrine def nonreg anemia
hypothyroidism, hypoadrenocoritcism (addison’s)
hypoadrenocoritcism (Addison’s dz) causes def of what important hormones to RBC formation
glucocorticoids and minerocorticoids
nutritional deficiency that leads to RBC maturation defect anemia (less common, seen more in LA and with unbalanced homecooked diets)
- iron deficiency, more often due to blood loss than nutrition though
- trace mineral def = abnormal heme (copper, molybdenum, vit B6) and nuclear maturation (folate, cobalamin, cobalt)
hereditary defect in poodles where they have normal __ RBC
macrocytic (hereditary macrocytosis)
3 things that cause RBC maturation defect
- iron deficiency
- lead poisoning
- FeLV cats (macrocytic)
__anemia is a complication of chronic external blood loss (hemorrhage), except in piglets where it is a __ def
iron deficiency, nutritional
blood smear results for Fe def anemia
microcytic, hypochromic, +/- schistocytes (due to increased RBC fragility), Thrombocytosis
iron def anemia what should you look for
blood sucking parasites, bleeding GI or UG lesions
Chronic blood loss causes Fe def resulting in
anemia and RBC fragility
__ develops in Fe def anemia bc the amount of Fe left is inadequate for incorporation into heme for Hgb formation
hypochromasia
Severe Fe def anemia vs initial Fe def anemia blood smear results
severe = microcytic, HYPOchromic initial = microcytic, NORMOchromic
__ is a beta-globulin protein made by the liver that binds/transports Fe and correlates with the TIBC
Transferrin
TIBC = total Fe binding capacity
__ is protein found inside cells and in low [plasma] that binds Fe for storage (BM and spleen)
Ferritin
where is iron stored
BM and spleen
plasma ferritin correlates with __ and can use prussian blue stain to evaluate BM fe stores
total body iron stores
In about 50% of iron def anemia cases will see __
thrombocytosis (increased platelets)
blood smear findings with Fe def anemia
crazy looking slide! microcytosis hypochromasia (severe) increased RBC fragility (poikelocytes - schysotcytes, keratocytes, acanthocytes) thrombocytosis (increased platelets)
Do not confuse the blood smear of Fe def anemia with
other life threatening fragmentation hemolysis (DIC, HW dz, glomerulonephritis, hemangiosarcoma)
How do you differentiate Fe def anemia from life threatening fragmentation hemolysis anemia
Fe def anemia= thrombocytosis
frag anemia = thrombocytopenia
with external blood loss will see __ and __
panhypoproteinemia (low albumin and globulins) and anemia
thrombocytopenia is seen with __ and __ (life threatening fragmentation hemolysis!)
DIC, hemangiosarcoma
__ can be seen early on in Fe def anemia but as Fe diminishes anemia becomes nonregenerative
polychromasia
lab findings for Fe def anemia
- low [serum Fe]
- norm/high TIBC (transferrin measurement - liver is still working)
- low saturation of transferrin with iron (not enough Fe)
- decreased serum ferritin (storage form)
3 and 4 are how ddx between Fe def and anemia of inflamm
How do you ddx between Fe def anemia and anemia of inflammatory dz (AID)?
decreased serum ferritin (storge Fe) and serum TIBC
Fe def lab results will show low saturation of transferrin:Fe (there is transferrin but not enough Fe)
HCT, MCV, and Serum Iron are __ in both iron def and AID anemias
decreased
Serum TIBC is __ in Fe def anemia and __ in AID
Fe def: normal to increased
AID: Normal to decreased
Serum ferritin is the best way to ddx between Fe def and AID, in Fe def it is __ and AID it is __
Fe def: decreased
AID: Norm to increased
increased nRBC are seen commonly in __
chronic lead poisoning (but can be due to other causes as well!)
normal __ maturation of RBC should see more mature cells than immature cells in circulation
pyramidal
__ is seen in lead poisoning along with certain other dz that cause non pyramidal maturation of RBC allowing more nRBC than polychromatophils in circulation
aberrant metarubricytosis
hallmark of lead poisoning
metarubricytosis (increased nRBC) WITHOUT polychromasia
other causes of aberrant metarubricytosis (increased nRBC) besides lead poisoning
- trauma/ischemia
- acute tissue anoxia (heat stroke, hypotension, choking, post-anesthetic crisis)
- BM dz/cancer
- cancer of RBC
- drugs (chemotherapeutics)
- extramedullary hematopoiesis
pathogenesis of chronic lead toxicity
lead interferes with Hgb synthesis and causes marrow stromal damage
response to chronic lead toxicity
disordered regenerative response (mostly nRBC, basophilic stippling, with no/little polychromasia)
in intramarrow dz list the decrease of cell lines from first to disappear to to last
neutrophils (10hr life) - platelets (10 d life) - RBC (100 d life)
cells with shorter life decrease first
since multiple cell lines may be affected by IM dz p may be at risk for
infection (leukopenia) and hemorrhage (thrombocytopenia)
most common immune mediated dz
NON-REGENERATIVE IMHA (BM or precursor cells effected)
4 things that can cause nonregen IMHA
- Marrow replacement (neoplasia or fibrosis)
- infectious dz (FeLV, parvo)
- drugs, toxins (bracken fern)
- radiation
2 reasons why TP can be high when PCV is low
dehydration and INFLAMMATION
