RBC 3- Non regenerative anemia

Question 1

Types of non regenerative anemia (because always persistant)

Answer 1

1. Anemia of inflammatory disease (AID)
   2.Anemia of chronic kidney disease (CKD)
2. Endocrine disease
3. Bone marrow disease

**do not include blood loss or hemolysis or iron deficiency because they just need more time or iron

Question 2

Anemia of inflammatory disease

Answer 2

-most common form
-mild to moderate anemia
-normocytic, normochromic
-often with inflammatory leukogram
-hyperglobulinemia, hyperfibrinogenemia

-little clinical significance because secondary to primary inflammatory disease

Question 3

When does anemia of inflammatory disease occur?

Answer 3

Within 3-10days
-from any chronic disorder with a inflammatory component (bacterial, fungal, viral, protozoal, or non infectious immune mediated, toxic, neoplastic, tissue injury)

Question 4

Pathogenesis of anemia from inflammatory disease

Answer 4

1.inflammatory cytokines lead to decreased iron availability
2. mediated by hepcidin leading to a reduced serum concentration of iron but more iron in the storage form
3. also see inhibited erythropoiesis and decreased RBC lifespan

**thought to be from an old innate non-specific antibacterial immune mechanism

Question 5

Difference between irone deficiency anemiia and AID

Answer 5

Iron deficiency anemia has total lack of iron in body so ferritin and hemosiderin will be low and transferrin will be high to try and find any iron it can

**in AID there is adequate iron stores but the difference is the body is sequestering iron away from bacteria etc.

Question 6

Anemia of chronic kidney disease

Answer 6

-seen in most animals with CKD
-mild to moderate anemia
-non regenerative
-normocytic and normochromic
-concurrent evidence of kidney disease

Question 7

How to detect Kidney disease (Renal azotemia)?

Answer 7

Chem panel: increased urea and creatinine

Urinalysis: minimally concentrated urine
*urine specific gravity <1.030 in dog or <1.035 in cat

Question 8

What does a urine that is adequately concentrated (high USG) mean?

Answer 8

Then azotemia is of prerenal origin (ie. due to dehydration)

Question 9

Pathogenesis of anemia of chronic kidney disease

Answer 9

Due to inadequate erythropoietin production from kidney damage
- decreased marrow response to erythropoietin so no stimulus to make more RBCs

Question 10

Anemia secondary to hypothyroidism

Answer 10

-mild anemia
-non regenerative
-normocytic, normochromic
-decreased T4

-decreased metabolic rate and O2 demands
-decreased eryropoietin production

Question 11

Anemia secondary to bone marrow disease

Answer 11

-CBC findings depend on the cause
-mild to marked anemia
-normocytic, normochromic … except some macrocytic eg. FeLV
-other cell lines may be affected

Question 12

Causes of bone marrow disease

Answer 12

-infectious agents
-immune-mediated destruction of precursors
-marrow replacement (fibrosis, neoplastic cells)
-drugs/toxins
-endocrine disease
-liver disease

Question 13

Pathogenesis of FeLV anemia

Answer 13

FeLV damages erythroid precursors resulting in decreased erythropoiesis and anemia and the potential production of defective RBCs =apoptosis

Question 14

What can FeLV anemia sometimes cause macrocytic cells?

Answer 14

**sometimes is macrocytic because defective maturation leads to decreased cell divisions and asynchronous maturation of nucleus and cytoplasm

Question 15

Immune mediated anemias

Answer 15

-marked anemia
-normocytic, normchromic
-non regenerative

Prolonged and aggressive immunosuppressive treatment
**need bone marrow evaluation to diagnose!

eg. PIMA and PRCA

Question 16

Precursor-directed immune mediated anemia (PIMA)

Answer 16

-similar to IMHA but is the RBC precursors in the bone marrow that are targeted and destroyed
-no polychromasia!

Question 17

Pure Red Cell aplasia (PRCA)

Answer 17

Earliest precursors are targeted and destroyed

Question 18

Anemia due to marrow replacement

Answer 18

Secondary to proliferation of neoplastic cells in bone marrow
-evidence of neoplasia
-Pancytopenia or bicytopenias
(NR anemia, Neutropenia, Thrombocytopenia)
-normocytic, normochromic
-unexplained increase in cell numbers

**bone marrow evaluation needed to diagnose