- none/vague if mild/ chronic - non-specific (lethargy, anorexia, collapse - Specific (pale MM, increased HR and RR, heart murmur, hyperdynamic pulse

- patient stable - HR - RR - demeanor - icterus - concurrent dz - pleural and peritoneal speaces - masses/ pain anywhere - rectal for melena

SA anaemia Flashcards by Emily Stacey

CS - anaemia

none/vague if mild/ chronic
non-specific (lethargy, anorexia, collapse
Specific (pale MM, increased HR and RR, heart murmur, hyperdynamic pulse

How well did you know this?

Not at all

Perfectly

What does CS severity reflect? 3

cause
chronicity
severity

How well did you know this?

Not at all

Perfectly

2 differentials - pale MM

poor peripheral perfusion
anaemia
distinguish by CRT. If

How well did you know this?

Not at all

Perfectly

How may signalment be relevant to pale MM cases?

young: lower PCV than adults (remember fleas, parasites etc)
older: neoplasia, renal, underlying problmes

How well did you know this?

Not at all

Perfectly

Hx questions to ask with pale mm

lifestyle
stable or deteriorating
site of bleeding ID’d
access to drugs/ toxins
travel

How well did you know this?

Not at all

Perfectly

PE - with pale MM

patient stable
HR
RR
demeanor
icterus
concurrent dz
pleural and peritoneal speaces
masses/ pain anywhere
rectal for melena

How well did you know this?

Not at all

Perfectly

How do diagnostically differentiate poor peripheral perfusion and anaemia

Manual PCV and TP

How well did you know this?

Not at all

Perfectly

When does TP decrease and increase:

decrease: haemorrhage

- increase: haemolysis or non-regenerative anaemia

How well did you know this?

Not at all

Perfectly

key question with anaemia

regenerative or non-regenerative

How well did you know this?

Not at all

Perfectly

What to examine for on blood smear

signs of regeneration (polychromasia, nRBC
evidence of underlying cause
immune-mediated destruction (spherocytes)
mechanical destruction (fragmentocytes)
infectious agents

How well did you know this?

Not at all

Perfectly

What does reticulocyte percentage need to be corrected for?

for the degree of anaemia
absolute reticulocyte count better: if > 60,000/microl in dogs or > 40,000 in cats then regenerative. Less than these figures suggests non-regenerative

How well did you know this?

Not at all

Perfectly

2 causes regenerative anaemia

blood loss

- haemolysis

How well did you know this?

Not at all

Perfectly

Describe regenerative anaemia

INTERNAL HAEMORRHAGE: spleen (dogs), thorax, trauma, amyloidosis (hepatic in cats)
EXTERNAL: epistaxis, gut, severe parasitic infestation (young), urinary tract

How well did you know this?

Not at all

Perfectly

What might you want to check with a regenerative aneamia d/t haemorrhage

TP (always)
coagulation profile
PLT count
faecal lungworm (only A.vasorum causes bleeding)
ACTH stimulation test (addisons associated with GIT ulcer leading to haemorrhage)
search body cavities

How well did you know this?

Not at all

Perfectly

Tx - blood loss anaemia

treat or remove underlying cause
remove spleen or piece of GIT etc
gastro-protectants if ulceration but not sx case
remove cause of ulceration
tx lungworm

How well did you know this?

Not at all

Perfectly

Describe TP and blood smear for regenerative anaemia d/t haemolysis

TP usually WNL, possible increase

- smear: evidence of underlying cause

How well did you know this?

Not at all

Perfectly

Outline regenerative anaemia d/t haemolysis

accelerated RBC destruction
intravascular or extravascular
EXTRA: macrophages in spleen, liver, mainly IgG mediated
INTRA: RBC lysis in circulation, IgM (possibly IgG)
autoagglutination? coombs?
haemoglobinuria?
bilirubinaemia?

Causes - haemolytic anaemia

IMHA (primary or idiopathic, secondary)
inherited (pyruvate kinase = PK deficiency, phosphofructokinase = PFK deficiency)
Infectious causes
Miscellaneous causes

Signalment - IMHA

spaniels

Dx - IMHA

regenerative anaemia?
no sign of blood loss
suggestion of haemolysis (jaudice, auto-agglutination with in-saline aggl test), spherocytes, ghost cells
r/o underlying dz (Babesia, Ehrlichia and non-blood cell infections)

pIMHA - tx

IVFT/ blood transfusion (hboc - oxyglobin not available0
immunosuppressive tx
? aspirin, clopidrogel (as increased risk of PTE)
? gastroprotectant meds
good nursing care (careful IV catheter maangement, cage rest with gentle walks)

What immunosuppresives can you give to pIMHA?

mainstay
second drug choice
others

PREDNISOLONE: suppression of macrophage activity, impaired complement and Ab binding, suppression of IgG production
Azathioprine (NOT in cats)
2nd drug choice: cyclosporine, chlorambucil (cats)
others: mycophenolate

Prognosis - pIMHA in dogs

GUARDED: icterus, haemoglobinuria/ anaemia (poorly regenerative), all poor prognostic indicators
PTE common cause of death (causes acute dyspnoea)
May relapse in future
monitor (regular PCV/ TP and haematology prior to each dose reduction and regular biochem for drug toxicity)

Outline IMHA in cats

primary (idiopathic) less common
more difficult to diagnose
giving blood products (if needed) tends to be more challenging to arrange than dogs

2 features - feline RBCs

- no central pallor - more prone to agglutinate * (both vs. dogs)

Infectious causes - haemolytic anaemoa

- Babesia canis in dogs - europe: travel scheme. B.gibsoni in some areas. Tx - imidocarb - Mycoplasma spp in cats (and dogs after splenectomy). Tx with doxycycline - any infxn can theoretically act as an immunological trigger --> secondary IMHA

Miscellaneous causes - haemolytic anaemia

- OXIDATIVE DAMAGE: paracetamol - cats, onions, garlic, Zn, Cu - Hypophosphataemia (DKA = diabetic ketoacidosis dogs prone to this) - shear injury (microangiopathic): damaged endothelium

How can reticulocytes indicate non-regenerative anaemia?

- reticulocyte %: needs to be corrected for the anaemia

Features - non-regenerative anaemia

- mild or severe - obvious or not on PE - approach varies with severity and if underlying cause obvious - non-regenerative anaemia patient may present in a variety of ways

List 5 causes of non-regenerative anaemia

- anaemia of chronic dz - anaemia of renal dz - FeLV infxn - misc. - BM dz

Outline non-regenerative anaemia d/t chronic dz

= anaemia of chronic inflammation - commonest cause of mild/moderate anaemia - mild to moderate anaemia is PCV of 25-36% in dogs and 18-26% in cats - chronic infxn and non-infectious disorders - d/t poor Fe storage/ utilisation, shortened RBC survival, impaired erythrocyte production - these animals don't always come in with an anaemia label

Outline non-regenerative anaemia d/t renal dz

- essentially all normocytic, normochrom. - pathogenesis: inadequate EPO production, decreased RBC lifespan, decreased BM response to EPO, other factors (haemorrhage d/t uraemic ulcers) - not always obvious

Outline non-regen anaemia d/t FeLV infxn

- always test for this in anemic cats - macrocytic normochrom, or normocytic normochromic with chronic dz - may induce IMHA/ primary BM dz - in past, >75% anaemic cats were FeLV positive

Miscellaneous causes of non-regenerative anaemia - 3

- NUTRIENT DEFICIENCY: Fe, Cu, folate or cobalamin - ENDOCRINE: hypothyroid or hypoadrenocorticism (both cause mild anaemia), hyperoestrogenism, usually only mild to moderate anaemia, severe panctypaenia with hyperostrogenism, LIVER DISEASE: e.g. PSS, usually mild-moderate anaemia

Outline non-regen. anaemia d/t BM dz - 5

- pure red cell aplasia - aplastic anaemia - neoplasia (myelophthisis) - myelodysplasia - myelofibrosis

Approach to non-regenerative anaemia

- depends on severity - similar investigation path to regenerative anaemia but ddx different - look for dz - if severe and no cause found on screening tests then do bone marrow aspirate/ biopsy - look for bi-/pancytopaenia on BM

Define pancytopaenia

deficiency of all 3 cellular components of blood (RBCs, WBCs, PLTs)

Method - BM samplign

- clip and prep aseptically (esp if on immunosuppressive tx) - aspirate (once obtained smear quickly as clots within seconds/ minutes) - core: roll preparations then into formalin

Tx - non-regenerative anaemia d/t BM dz

- pure red cell apalsia: similar to IMHA tx - aplastic anaemia: depends on cause (infxn, drug) - neoplasia (myelophthisis) - myelodysplasia - myelofibrosis: depends on extent, if primary dz under control then myelofibrosis reverses

What should you examine RBC count/ PCV in light of?

in light of TP