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Lymphoreticular and haematopoeitic > SA anaemia > Flashcards

SA anaemia Flashcards

1
Q

CS - anaemia

A
  • none/vague if mild/ chronic
  • non-specific (lethargy, anorexia, collapse
  • Specific (pale MM, increased HR and RR, heart murmur, hyperdynamic pulse
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2
Q

What does CS severity reflect? 3

A
  • cause
  • chronicity
  • severity
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3
Q

2 differentials - pale MM

A
  • poor peripheral perfusion
  • anaemia
  • distinguish by CRT. If
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4
Q

How may signalment be relevant to pale MM cases?

A
  • young: lower PCV than adults (remember fleas, parasites etc)
  • older: neoplasia, renal, underlying problmes
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5
Q

Hx questions to ask with pale mm

A
  • lifestyle
  • stable or deteriorating
  • site of bleeding ID’d
  • access to drugs/ toxins
  • travel
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6
Q

PE - with pale MM

A
  • patient stable
  • HR
  • RR
  • demeanor
  • icterus
  • concurrent dz
  • pleural and peritoneal speaces
  • masses/ pain anywhere
  • rectal for melena
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7
Q

How do diagnostically differentiate poor peripheral perfusion and anaemia

A
  • Manual PCV and TP
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8
Q

When does TP decrease and increase:

A
  • decrease: haemorrhage

- increase: haemolysis or non-regenerative anaemia

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9
Q

key question with anaemia

A

regenerative or non-regenerative

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10
Q

What to examine for on blood smear

A
  • signs of regeneration (polychromasia, nRBC
  • evidence of underlying cause
  • immune-mediated destruction (spherocytes)
  • mechanical destruction (fragmentocytes)
  • infectious agents
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11
Q

What does reticulocyte percentage need to be corrected for?

A
  • 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
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12
Q

2 causes regenerative anaemia

A
  • blood loss

- haemolysis

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13
Q

Describe regenerative anaemia

A
  • INTERNAL HAEMORRHAGE: spleen (dogs), thorax, trauma, amyloidosis (hepatic in cats)
  • EXTERNAL: epistaxis, gut, severe parasitic infestation (young), urinary tract
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14
Q

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

A
  • 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
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15
Q

Tx - blood loss anaemia

A
  • 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
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16
Q

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

A
  • TP usually WNL, possible increase

- smear: evidence of underlying cause

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17
Q

Outline regenerative anaemia d/t haemolysis

A
  • 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?
18
Q

Causes - haemolytic anaemia

A
  • IMHA (primary or idiopathic, secondary)
  • inherited (pyruvate kinase = PK deficiency, phosphofructokinase = PFK deficiency)
  • Infectious causes
  • Miscellaneous causes
19
Q

Signalment - IMHA

A

spaniels

20
Q

Dx - IMHA

A
  • 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)
21
Q

pIMHA - tx

A
  • 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)
22
Q

What immunosuppresives can you give to pIMHA?

  • mainstay
  • second drug choice
  • others
A
  • 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
23
Q

Prognosis - pIMHA in dogs

A
  • 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)
24
Q

Outline IMHA in cats

A
  • primary (idiopathic) less common
  • more difficult to diagnose
  • giving blood products (if needed) tends to be more challenging to arrange than dogs
25
Q

2 features - feline RBCs

A
  • no central pallor
  • more prone to agglutinate
  • (both vs. dogs)
26
Q

Infectious causes - haemolytic anaemoa

A
  • 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
27
Q

Miscellaneous causes - haemolytic anaemia

A
  • OXIDATIVE DAMAGE: paracetamol - cats, onions, garlic, Zn, Cu
  • Hypophosphataemia (DKA = diabetic ketoacidosis dogs prone to this)
  • shear injury (microangiopathic): damaged endothelium
28
Q

How can reticulocytes indicate non-regenerative anaemia?

A
  • reticulocyte %: needs to be corrected for the anaemia
29
Q

Features - non-regenerative anaemia

A
  • 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
30
Q

List 5 causes of non-regenerative anaemia

A
  • anaemia of chronic dz
  • anaemia of renal dz
  • FeLV infxn
  • misc.
  • BM dz
31
Q

Outline non-regenerative anaemia d/t chronic dz

A

= 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
32
Q

Outline non-regenerative anaemia d/t renal dz

A
  • 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
33
Q

Outline non-regen anaemia d/t FeLV infxn

A
  • 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
34
Q

Miscellaneous causes of non-regenerative anaemia - 3

A
  • 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
35
Q

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

A
  • pure red cell aplasia
  • aplastic anaemia
  • neoplasia (myelophthisis)
  • myelodysplasia
  • myelofibrosis
36
Q

Approach to non-regenerative anaemia

A
  • 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
37
Q

Define pancytopaenia

A

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

38
Q

Method - BM samplign

A
  • 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
39
Q

Tx - non-regenerative anaemia d/t BM dz

A
  • 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
40
Q

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

A

in light of TP

Lymphoreticular and haematopoeitic (21 decks)

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