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Clinical Pathology Exam 1 > Lecture 6 - non regenerative anemias > Flashcards

Lecture 6 - non regenerative anemias Flashcards

1
Q

nonregenerative anemias __ are minimal or absent and is often has normal __ and __ values (except iwth deficiencies like iron)

A

polychromasia/reticulocytosis, MCV (normocytic) and MCHC (normochormic)

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2
Q

are clinical signs of anemia present with nonregenerative anemias

A

absent or mild

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3
Q

__ can cause selective depression of EPO which cuases BM activity reduction and RBC maturation defects

A

systemic dz outside the BM (extramarrow dz)

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4
Q

inadequate or abnormal hematopoiesis due to __ causes a reduction of all cell types

A

primary BM dz (intramarrow dz)

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5
Q

what non-regenerative anemia would you expect to see only anemia (only RBC decreased)

A

extramarrow/systemic dz

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6
Q

List the humoral factors that support RBC production in BM

A
  1. EPO (kidney)
  2. Iron (liver)
  3. endocrine hormones (pituitary, thyroid, glucocorticoids, androgens)
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7
Q

Do you need to collect a BM sample to dx cause of nonregenerative anemia?

A

NO, can rule out systemic dz (renal/liver dz, inflammation, extramarrow cancer, endocrine disorder)

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8
Q

patients with __ renal failure are anemic, while patients with __ renal failure are usually NOT anemic

A

Chronic (>100days), acute

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9
Q

blood smear findings with chronic renal dz nonregenerative anemia

A

mild to moderate, normocytic, normochromic, nonregenerative anemia. serum/urine chem changes consistent with renal dz

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10
Q

what is the MOST COMMON nonregenerative anemia of domestic animals

A

anemia of chronic inflammatory dz

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11
Q

__ released with inflammation make the BM nonresponsive to EPO

A

inflammatory cytokines

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12
Q

most __ have infalmmatory components

A

chronic dz
nonifections -IM, neoplastic, toxic or
infectious - bact, fungal, viral, protozoal

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13
Q

The clinical signs seen with anemia of inflammatory dz are caused by

A

underlying dz, NOT the anemia (anemia will improve when dz is treated)

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14
Q

Cytokines released during inflammation cause __ to be stored (not available to make RBC) which impairs BM repsonse to EPO and shortens RBC survival

A

iron

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15
Q

blood smear/lab findings with chronic inflammation nonreg anemia

A
  1. mild to mod, normocytic/chromic, nonregenerative anemia with LITTLE OR NO Poikilocytosis (abnormal shaped cells)
  2. chronic inflamm leukogram
  3. hyperglobulinemia (intravascular hemolysis)
  4. decrease in serum iron
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16
Q

__ 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

A

ferritin, BM and spleen, transferrin

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17
Q

What anemia looks similar to iron deficiency anemia?

A

nonreg anemia of chronic inflammatory dz

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18
Q

chronic liver dz causes

A

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.

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19
Q

blood smear/lab findings with chronic liver dz nonreg anemia

A
  1. mild to moderate, normocytic, normochromic, nonregnerative anemia
  2. Poikelocyte = Acanthocytes (uneven spicules)
  3. . low MCV or MCHC occationally seen (due to Hgb:SA ratio)
  4. serum/urine biochem seen with liver dz.
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20
Q

Poikelocyte seen with non reg chronic liver dz anemia

A

acanthocytes

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21
Q

__ and __ are common endocrine def in older dogs and can cause endocrine def nonreg anemia

A

hypothyroidism, hypoadrenocoritcism (addison’s)

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22
Q

hypoadrenocoritcism (Addison’s dz) causes def of what important hormones to RBC formation

A

glucocorticoids and minerocorticoids

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23
Q

nutritional deficiency that leads to RBC maturation defect anemia (less common, seen more in LA and with unbalanced homecooked diets)

A
  1. iron deficiency, more often due to blood loss than nutrition though
  2. trace mineral def = abnormal heme (copper, molybdenum, vit B6) and nuclear maturation (folate, cobalamin, cobalt)
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24
Q

hereditary defect in poodles where they have normal __ RBC

A

macrocytic (hereditary macrocytosis)

25
Q

3 things that cause RBC maturation defect

A
  1. iron deficiency
  2. lead poisoning
  3. FeLV cats (macrocytic)
26
Q

__anemia is a complication of chronic external blood loss (hemorrhage), except in piglets where it is a __ def

A

iron deficiency, nutritional

27
Q

blood smear results for Fe def anemia

A

microcytic, hypochromic, +/- schistocytes (due to increased RBC fragility), Thrombocytosis

28
Q

iron def anemia what should you look for

A

blood sucking parasites, bleeding GI or UG lesions

29
Q

Chronic blood loss causes Fe def resulting in

A

anemia and RBC fragility

30
Q

__ develops in Fe def anemia bc the amount of Fe left is inadequate for incorporation into heme for Hgb formation

A

hypochromasia

31
Q

Severe Fe def anemia vs initial Fe def anemia blood smear results

A 
severe = microcytic, HYPOchromic 
initial = microcytic, NORMOchromic
32
Q

__ is a beta-globulin protein made by the liver that binds/transports Fe and correlates with the TIBC

A

Transferrin

TIBC = total Fe binding capacity

33
Q

__ is protein found inside cells and in low [plasma] that binds Fe for storage (BM and spleen)

A

Ferritin

34
Q

where is iron stored

A

BM and spleen

35
Q

plasma ferritin correlates with __ and can use prussian blue stain to evaluate BM fe stores

A

total body iron stores

36
Q

In about 50% of iron def anemia cases will see __

A

thrombocytosis (increased platelets)

37
Q

blood smear findings with Fe def anemia

A 
crazy looking slide! 
microcytosis 
hypochromasia (severe) 
increased RBC fragility (poikelocytes - schysotcytes, keratocytes, acanthocytes)
thrombocytosis (increased platelets)
38
Q

Do not confuse the blood smear of Fe def anemia with

A

other life threatening fragmentation hemolysis (DIC, HW dz, glomerulonephritis, hemangiosarcoma)

39
Q

How do you differentiate Fe def anemia from life threatening fragmentation hemolysis anemia

A

Fe def anemia= thrombocytosis

frag anemia = thrombocytopenia

40
Q

with external blood loss will see __ and __

A

panhypoproteinemia (low albumin and globulins) and anemia

41
Q

thrombocytopenia is seen with __ and __ (life threatening fragmentation hemolysis!)

A

DIC, hemangiosarcoma

42
Q

__ can be seen early on in Fe def anemia but as Fe diminishes anemia becomes nonregenerative

A

polychromasia

43
Q

lab findings for Fe def anemia

A
  1. low [serum Fe]
  2. norm/high TIBC (transferrin measurement - liver is still working)
  3. low saturation of transferrin with iron (not enough Fe)
  4. decreased serum ferritin (storage form)

3 and 4 are how ddx between Fe def and anemia of inflamm

44
Q

How do you ddx between Fe def anemia and anemia of inflammatory dz (AID)?

A

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)

45
Q

HCT, MCV, and Serum Iron are __ in both iron def and AID anemias

A

decreased

46
Q

Serum TIBC is __ in Fe def anemia and __ in AID

A

Fe def: normal to increased

AID: Normal to decreased

47
Q

Serum ferritin is the best way to ddx between Fe def and AID, in Fe def it is __ and AID it is __

A

Fe def: decreased

AID: Norm to increased

48
Q

increased nRBC are seen commonly in __

A

chronic lead poisoning (but can be due to other causes as well!)

49
Q

normal __ maturation of RBC should see more mature cells than immature cells in circulation

A

pyramidal

50
Q

__ is seen in lead poisoning along with certain other dz that cause non pyramidal maturation of RBC allowing more nRBC than polychromatophils in circulation

A

aberrant metarubricytosis

51
Q

hallmark of lead poisoning

A

metarubricytosis (increased nRBC) WITHOUT polychromasia

52
Q

other causes of aberrant metarubricytosis (increased nRBC) besides lead poisoning

A
  1. trauma/ischemia
  2. acute tissue anoxia (heat stroke, hypotension, choking, post-anesthetic crisis)
  3. BM dz/cancer
  4. cancer of RBC
  5. drugs (chemotherapeutics)
  6. extramedullary hematopoiesis
53
Q

pathogenesis of chronic lead toxicity

A

lead interferes with Hgb synthesis and causes marrow stromal damage

54
Q

response to chronic lead toxicity

A

disordered regenerative response (mostly nRBC, basophilic stippling, with no/little polychromasia)

55
Q

in intramarrow dz list the decrease of cell lines from first to disappear to to last

A

neutrophils (10hr life) - platelets (10 d life) - RBC (100 d life)
cells with shorter life decrease first

56
Q

since multiple cell lines may be affected by IM dz p may be at risk for

A

infection (leukopenia) and hemorrhage (thrombocytopenia)

57
Q

most common immune mediated dz

A

NON-REGENERATIVE IMHA (BM or precursor cells effected)

58
Q

4 things that can cause nonregen IMHA

A
  1. Marrow replacement (neoplasia or fibrosis)
  2. infectious dz (FeLV, parvo)
  3. drugs, toxins (bracken fern)
  4. radiation
59
Q

2 reasons why TP can be high when PCV is low

A

dehydration and INFLAMMATION

Clinical Pathology Exam 1 (12 decks)

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