Pale Mucous Membranes Flashcards
Identifying the problem for pale mm?
Poor peripheral perfusion or anemia
CS of anemia
Hemorrhage
Hemolysis
BM failure
Pale mm
CS of Poor peripheral perfusion
Heart failure
Shock
Dehydration
Different classifications of anemia
Acute, regenerative or non-regenerative
BM response
3-4 days
Full marrow response by 7 days
Microcytosis
Small RBCs
From iron deficiency and partacaval shunt
Macrocytosis
Large RBCs
From Regeneration*, breed effect (poodles), and FeLV
Evidence of regeneration
Polychromasia (size variation), macrocytosis, poikilocytosis, reticulocytosis (retained nuclear material) , nucleated RBCs
What is the best assessment of regeneration?
Reticulocyte count (corrected v uncorrected, absolute count)
Cat reticulocytes
Punctate (mature, past regeneration, not included in reticulocyte count)
Aggregate (true indicator of recent regeneration)
Nucleated RBCs (normoblasts)
More immature than reticulocytes (less of them)
Should be >1
Appropriate normoblastemia
Intense regenerative anemia from blood loss and hemolysis
+ significant reticulocytes
Inappropriate normoblastemia
More NRBCs than reticulocytes
Peracute anemia, splenic disorders (hemangiosarcoma), normal mini schnauzers and dachshunds, lead toxicity, BM disorders
Cat normoblasts
Few, sometimes numerous in peripheral blood of sick cats (conditions other than lead toxicity)
Without evidence of intense erythrogenesis
Hemolytic anemia classifications
Extravascular or intravascular
Intravascular hemolysis
In centrifuged plasma
With Hburia
Jaundice common
What causes hemolytic anemia?
Immune mediated
Microangiopathic (RBCs damaged)
Congenital (enzyme deficiency)
Infectious
Drugs/toxins (heinz bodies from garlic and onions)
Hemorrhagic anemia causes
External: trauma, coagulopathy and bleeding lesion in GI or urinary tract
Internal: Trauma, hemangiosarcoma, coagulopathy
Hemolytic anemia v internal hemorrhage
More regenerative than anemia due to external blood loss
Plasma protein levels normal or ↑ (hemolysis)
What affects plasma protein levels?
Acute hemorrhage (↓)
Chronic external hemorrhage (↓)
Hemolysis (↑)
What can cause Spherocytosis?
Immune mediated hemolysis
Mononuclear phagocytic neoplasm
Splenic pathology
What can cause shistocytosis?
Blood forced through narrow passages (microangiopathy) → splenic damage, hemangiosarcoma, DIC, vasc. neoplasm, glomerulonephritis
Physically damaged (endocarditis)
Caval syndrome
Acanthocytosis
Forms due to altered lipid: cholesterol ratios in RBC membrane
Associated with hemangiosarcoma, glomerulonephritis, lymphoma and hepatic disease
Heinz bodies
Round structure from RBC or retractile spot in cytoplasm
Oxidation → denatured, precipitated Hb
If removed may leave spherocyte
Heinz bodies will __________ RBC flexibility and cause ___________
- ↓
- Intravascular hemolysis
Heinz bodies in cats
Most common because more susceptible to oxidation (spleen less efficient @ removal)
10% of RBCs may contain HBs
What causes heinz bodies in cats?
Onions, garlic, wilted red maple leaves, paracetamol (acetaminophen), propylene glycol and propofol
Non-regenerative anemia
Anemia of chronic disease
Renal failure
Oestrogen toxicity
Primary BM disorders: Red cell aplasia, myelophthisis, dyserythropoiesis
Iron deficiency
Immune mediated
Hypothyroidism
Most common cause of non-regenerative anemia
Anemia of a chronic disease
Associated with inflamm or neoplastic disease
