Non-regenerative Anemia / Polycythemia

Question 1

what do we see, broadly, in the case of a primary bone marrow disorder?

Answer 1

-generalized depression
-multiple cytopenias

Question 2

what do we see, broadly, in the case of a secondary bone marrow disorder?

Answer 2

selective red cell depression

Question 3

how can primary bone marrow disease arise?

Answer 3

Progenitor cells can be injured by exposure to chemicals, drugs, toxins, irradiation, viruses and through immune-mediated mechanisms. Usually these injuries are not cell-line specific or occur early enough in differentiation that common stem cells are affected; the result is that multiple cell lines are affected

Question 4

what do we see in the peripheral blood in cases of primary one marrow disease?

Answer 4

nonregenerative anemia, leukopenia, and thrombocytopenia

Question 5

what 4 broad categories of primary bone marrow disease are there?

Answer 5

-hypoplasia or aplasia
-myelodysplasia
-leukemia
-other reasons for myelophthisis

Question 6

what can cause bone marrow hypoplasia or aplasia?

Answer 6

-Infectious – eg. FeLV, ehrlichiosis
-Drug/chemical toxicity
-Immune-mediated

Question 7

what are some examples of drugs/chemicals that can result in bone marrow aplasia or hypoplasia?

Answer 7

◦ Estrogen
◦ Phenobarbital
◦ Griseofulvin
◦ Cephalosporins
◦ Chemotherapeutic agents

Question 8

what are some factors that can result in estrogen toxicity?

Answer 8

-Exogenous administration
-Sertoli cell tumors
-Persistent estrus in ferrets

Question 9

what are the criteria for diagnosis of Myelodysplasia/Myelodysplastic
Syndrome

Answer 9

◦ Peripheral blood cytopenia(s)
◦ Normal to hypercellular bone marrow
◦ Dysplastic features

Question 10

what is leukemia?

Answer 10

Myeloproliferative disease is used interchangeably with leukemia to denote hematopoietic neoplasia arising from bone marrow cells

-Tumor of developing red cells, white cells (except lymphs) or platelets
-Can replace normal marrow with neoplastic cells

Question 11

what is myelophthisis?

Answer 11

displacement of hemopoietic bone-marrow tissue by fibrosis, tumors, or granulomas. The word comes from the roots myelo-, which refers to bone marrow, and phthysis, shrinkage or atrophy.
- leading to peripheral cytopenias

Question 12

what is myelofibrosis and what is its cause?

Answer 12

-proliferation of fibroblasts within the bone marrow cavity caused by:
 FeLV-related
 Marrow necrosis
 Neoplasia
 Chronic hemolytic anemia
=> often the cause in unknown

Question 13

what are dacrocytes and when do we see them?

Answer 13

These tear drop cells are found primarily in diseases with bone marrow fibrosis, such as: primary myelofibrosis, myelodysplastic syndromes during the late course of the disease, rare form of acute leukemias and myelophthisis caused by metastatic cancers

Question 14

what do we see in the blood in a case of primary bone marrow disease?

Answer 14

Non-regenerative anemia
Leukopenia +/- abnormal cells
Thrombocytopenia

Question 15

what do we in the blood in a case of secondary bone marrow disease?

Answer 15

Non-regenerative anemia
Normal or increased leukocytes
Normal or increased platelets

Question 16

what 5 factors are often the cause of secondary bone marrow disease?

Answer 16

-chronic inflammation
-endocrine disease
-FeLV related
-metastatic neoplasia
-renal disease

Question 17

what causes anemia of chronic disease? What are its charactieristics?

Answer 17

-Inflammation (infectious/non-infectious) & neoplasia
-Due to poor iron availability, suppressive cytokines
-Usually mild-moderate
◦ E.g dog: HCT usually between .20 and .30 (ref int.
.37-.55)
-Normocytic, normochromic anemia

Question 18

what hormone deficiencies can cause anemia of endocrine disease?

Answer 18

◦ Cortisol
◦ Androgens
◦ Thyroxine
◦ Growth hormone

Question 19

what are the characteristics of anemia that results from FeLV infection?

Answer 19

Anemia can be normocytic or macrocytic
Can cause nonregenerative anemia via:
◦ Anemia of chronic disease
◦ Myelophthisis from hematologic neoplasia
◦ Pure red cell aplasia (PRCA)

Question 20

what are the characteristics of anemia of renal disease? what are its characteristics?

Answer 20

Usually a moderate anemia, may be worse if bleeding or decreased platelet function
Due to:
• Decreased red cell life span
• Decreased Epo production
• Decreased marrow responsiveness to Epo

Question 21

what can Rubricytosis, Lead Toxicity, or Vitamin & Mineral
Deficiencies lead to

Answer 21

anemia due to secondary bone marrow disease

Question 22

with polycythemia, how will RBC, Hgb, and Hct values be impacted?

Answer 22

increased

Question 23

what is polycythemia? what are the broad categorizations?

Answer 23

increased number of red cells in the blood, due to primary disease or a secondary condition
-Relative polycythemia: normal red cell mass
-Absolute polycythemia: increased red cell mass

Question 24

what are the types of absolute polycythemia?

Answer 24

Primary: Decreased-Normal Epo, Normal PO2
Secondary: Increased Epo, Low PO2

Question 25

what causes primary absolute polycythemia?

Answer 25

 Myeloproliferative disease: polycythemia vera or erythrocytosis

Question 26

what causes secondary absolute polycythemia?

Answer 26

Many causes (Cariopulmonary disease, high altitude, hormone excess, renal masses, paraneoplastic)

Question 27

what is the most common cause of polycythemia?

Answer 27

dehydration

Question 28

what causes relative polycythemia? what are its identifying characteristics?

Answer 28

dehydration or splenic contraction
No change in Epo or PO2

Question 29

what is polycythemia vera

Answer 29

PV is a myeloproliferative disease involving neoplastic transformation of an erythroid stem cell. The red cells are morphologically normal

Question 30

what do we sometimes see in long-standing cases of absolute polycythemia and why?

Answer 30

there will be increased demand for iron. For this reason, microcytosis and hypochromia are sometimes observed in long-standing cases of absolute polycythemia