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Clinical Pathology > Week 2 - Anemia Part 1 > Flashcards

Week 2 - Anemia Part 1 Flashcards

1
Q

Define anemia.

A

Decrease in red blood cell (RBC) mass.

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2
Q

How is RBC mass measured?

A

RBC mass measured by PCV/HCT, RBC count, and Hgb concentration

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3
Q

What are the clinical signs of anemia?

A
  • Pale mucous membranes
  • Lethargy, reduced exercise tolerance
  • Increased capillary refill time (>2 seconds)
  • tachypnea (Increased respiratory rate)
  • Dyspnea (shortness of breath)
  • Tachycardia (increased heart rate)
  • Murmurs if <20% (increased turbulence)
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4
Q

What are the non-specific clinical signs of anemia?

A

–> Probably related to underlying illness
* Weight loss
* Fever
* Lymphadenopathy
* Polyuria
* Polydypsia

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5
Q

Anemia Signs associated with blood destruction are?

A
  • Splenomegaly
  • Icterus (jaundice)
  • Hemoglobinuria (HgB in urine even after centrifugation).
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6
Q

Duration of onset of anemia may impact clinical signs. How?

A

May impact the severity of the clinical signs
* SLOW onset –> less severe
* RAPID onset –> more severe

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7
Q

How do you approach an anemia patient?

A
  1. Lab evaluation
    * Red blood cell mass (PCV)
    * Mean cell volume
    * Reticulocyte count
    * Total protein
  2. History
  3. Physical examination
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8
Q

How is anemia classified?

A
  1. Based on the response of the bone marrow
    * Regenerative
    * Non-regenerative
  2. Based on RBC Indices (size and chromasia)
    * MCV & MCHC
  3. Based on pathophysiologic mechanisms
    * Blood loss (hemorrhage)
    * Accelerated RBC destruction (dec. RBC life span) by Intra- or Extravascular hemolysis
    * Reduced or defective erythropoiesis
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9
Q

What can be seen in this image?

A

Normal RBC in a horse
M = macrocytes

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10
Q

What are the major causes of regenerative anemia?

A
  1. Blood loss
  2. Blood destruction/hemolysis
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11
Q

How can blood loss lead to anemia??
What is the difference between acute and chronic blood loss?

A

b/c not enough iron to replenish.

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12
Q

What are two major characteristics of acute blood loss?

A
  1. Protein decreases along with PCV
    * Usually returns to normal within one week if not
    ongoing blood loss. plasma protein decreases together but with time the protein will adjust itself.
  2. Normal Erythrocyte morphology –usually-
    * Exception in dogs with Hemangiosarcoma; acute blood loss due to bleeding. When rupture –> large amounts of blood loss
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13
Q

What cells are reported in cases of acute blood loss? Identify them in the image below

A

Acanthocytes and schistocytes –> Hemangiosarcoma

Or in blood loss?

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14
Q

List some examples of acute blood loss

A
  • Trauma & Surgery
  • Coagulation disorders
  • Bleeding tumors- Hemangiosarcoma
  • Thrombocytopenia (<25,000/ul)
  • blood loss does not cause thrombocytopenia. Thrombo causes blood loss
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15
Q

How are RBC’s regenerated?
How long does this process take?

A

See below

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16
Q

List some examples of chronic blood loss.
In which part of the body is it most common to lose blood?

A
  • Gastrointestinal (GI) ulcer
  • Bleeding GI tumor
  • Parasites (blood consuming)
  • Hookworms, whipworms

Blood loss via the intestine is the most common

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17
Q

What parasite is pictured below?
Describe its size.
In which part of the body can this parasite be found? How does it impact the host?

A

Ancylostoma caninum - Hookworm
small parasite
live in GI tract of dogs and cats
attaches to stomach lining and ingests blood directly

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18
Q

Chronic blood loss induces deficiencies, especially in adults. We see iron deficiency anemia in nursing animals - why? In adults as well - why?

A
  • Nursing animals due to Inadequate intake
  • In adults, almost always due to CHRONIC blood loss
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19
Q

What lab findings do we see in iron deficiency anemia?

A
  1. Microcytosis = low MCV
  2. Reticulocytes are present and also have decreased MCV
  3. RDW usually increased (anisocytosis aka variation of RBC)
    - This is a Calculated parameter: Index of degree of RBCs anisocytosis
  4. MCHC often normal (Unlike in humans)
  5. Anemia usually regenerative, unless concurrent
    anemia of inflammatory disease
  6. Thrombocytosis common having an elevated level of platelets in blood
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20
Q

Patient presents to you and you diagnose them with anemia. You perform a blood cytology and see this:

A

Lab findings in Fe def. anemia
* Blood film examination often useful
* keratocyte formation, inc central pallor

21
Q

In the case of iron deficiency, what other ab findings are provided, not from the erythrogram, but from serum chemistry?

A
  1. Decreased serum iron concentration
  2. Decreased transferrin saturation
  3. Decreased storage iron (ferritin concentrations or hemosiderin in bone marrow)
  4. Total iron binding capacity usually normal in dogs and cats (usually increased in other species)
22
Q

What are the major lab indicators of Fe. def. anemia?

A

Diagnosis (Dx) of Fe def. anemia
* Anemia (low PCV)
* Microcytosis (low MCV)
* Low serum iron

23
Q

Differential Diagnosis (DDx) for Microcytosis/low MCV

A
  • due to portosystemic shunts
  • due to breed predisposition: Shiba Inus, Akitas
  • due to anemia of inflammatory disease
  • On these cases Usually normocytic but some may have microcytosis. But we can differentiate, because anemia of inflammatory disease will have increased storage iron.
24
Q
A

Low PCV = anemic
Retics = regenerative
MCV = normocytic
MCHC = normochromic
Prot = normo proteinemia

Blood film findings –> hemangiosarcoma
Has acute anemia, protein not decreased enough

25
Q
A

Low PCV = anemia
LOW MCV = microcytic
Low MCHC = hypochromic
absRC = slightly regenerative anemia
T Prot = hypoproteinemia (could be due to chronic blood loss due to ulcer, parasites, etc).

Blood film findings
Anemia of iron deficiency due to low MCV and PCV and blood film findings

26
Q

Explain how blood destruction/hemolysis causes regenerative anemia.

A
  • Hemolysis = RBC destruction
  • 2 types
    1. Intravascular Hemolysis
    Within blood vessels or heart
    2. Extravascular Hemolysis
  • Outside capillary-arterial-venous system (unrelated To hemorrhage)
  • Phagocytosis of RBCs –Macrophages in Spleen, liver, etc
    Most conditions have both components
27
Q

List the characteristics of hemolytic anemia.

A
  • +/- Splenomegaly
  • Icterus
  • +/- Hyperbilirrubinemia
  • Total protein normal
  • +/- RBC morphology changes related to the cause of the hemolytic anemia
  • E.g. Spherocytes, eccentrocytes, Heinz bodies, infectious organisms
28
Q

List the characteristics of intravascular hemolytic anemia.

A

Intravascular hemolytic anemia patients may present with either of these.

29
Q

Name the causes of hemolysis.

A

“HOT In CIZR”
1. Immune-mediated hemolytic anemia
2. Oxidative damage
- Heinz body anemia
3. Hypophosphatemia
4. Thermal injury
5. Zinc toxicosis
6. Copper Molybdenum deficiency (sheep)
7. Inherited RBC enzyme deficiencies
8. RBC parasites, bacterial, viral infections

30
Q

IMHA
1. This is the most common in which species?
2. What other species can this disease be seen in?
3. This disease occurs secondary to?

A

Immune-Mediated Hemolytic Anemia (IMHA)
* Most common hemolytic anemia in dogs
* Also seen in cats, horses, and cattle
* Often secondary to other diseases or events
* Various causes
* Idiopathic
* Infection
* Drug-induced
* Vaccine-induced (modified live virus types)
* Neoplasia
* Alloimmune

31
Q

What infectious agents can cause IMHA?

A
  • Post Streptococcus equi var equi infection in horses
    (Strangles)
  • Clostridium perfringens in horses
  • Babesiosis in dogs and cats –> extravasuclar hemolutic anemia.
  • FeLV in cats
  • Mycoplasma haemofelis
  • Anaplasma in dogs and cats

Intravascular hemolysis –> IMHA

32
Q

What drugs can induce IMHA?Drug induced IMHA

A
  • Drugs
  • Penicillin & Trimethoprim-sulfamethoxazolen –> IMHA in horses
  • Cephalosporins
  • Levaminsole
33
Q

Name the different types of Neoplasia assoc. with IMHA

A
  • Lymphoma in horses
  • Lymphoma/lymphoid leukemia in dogs and cats
34
Q

Name the Alloimmune conditions associated with IMHA

A
  • Neonatal isoerythrolysis (NI)
  • Neonatal Isoerythrolysis, NI, occurs in foals when there is an incompatibility between the foal’s and mare’s blood type.
  • Incompatible blood transfusions
35
Q

What are the characteristics of Blood film
findings of IMHA?

A
  1. Polychromasia/reticulocytosis (regenerative)
  2. Spherocytes in large numbers
    * Smaller than normal RBC; no central pallor
  3. +/- Ghost cells (RBC that look very pale in blood film).
    * If intravascular hemolysis
  4. Autoagglutination
    * Differentiate from Rouleaux formation via
    saline dilution test
36
Q
A

Spherocytes
Canine IMHA: nearly all the cells in this field are spherocytes, as indicated by their decreased diameter, dense staining properties, and lack of central pallor.

37
Q
A

Left = Rouleux
Right = Agglutination (good indication of IMHA). Add saline to tell difference.Saline will not correct and agglutination stays

38
Q

Coombs test looks for particular IG. What does a positive Coombs test mean?

A
  • Positive direct Coombs test
    • A direct Coombs test assesses for the presence of immunoglobulin (IgM, IgG) or complement (C3b, C3d) on RBC using a Coombs reagent, which consists of species-specific anti-Ig and/or anti-C3
    • A positive Coombs test is supportive evidence of IMHA, but there are MANY false positives and negatives
  • A Coombs test may not be indicated if there is clear evidence of IMHA (many spherocytes) or saline agglutination is persistent after washing
39
Q

Oxidative damage:
1. Heinz bodies are ?
2. Which species are most susceptible to developing heinz bodies? Why? Occurs in what diseases?
3. What happens to RBCs in the case of Heinz Body anemia?

A
  1. denatured hemoglobin
  2. Cats most susceptible. Unique Hgb structure & normal healthy cats have a small % of Heinz bodies
  3. Diabetes mellitus, Lymphoma, Hyperthyroidism
  4. Extensive heinz bodies: attached to membrane, these RBC can be susceptible to fragmentation and entrapment in the spleen -> phagocytized –> anemia
40
Q

Name the two cells pictured below.
What process are they indicative of?

A
41
Q

What cell is pictured below?
What stain is being used?

A

New Methylene Blue (NMB) stain
Heinz Body

42
Q

Ingestion of what plants cause heinz body anemia in animals?

A

Heinz body anemia
* Plants
* Allium family (Onion, Garlic)
* Brassica (Kale, cabbage, rape)
* Wilted red maple leaves (Acer rubrum) pathogeneiss is unkown.

43
Q

What are the drug and chemical causes of heinz body anemia?

A
  • Drugs and chemicals
    § Acetaminophen (paracetamol)
    § Propylene glycol (drug stabilizer in topical, oral, injectable meds).
    § Copper toxicosis (small ruminants)
    § Zinc
    § Selenium deficiency (ruminants)
44
Q

Define methemglobinemia. What is it caused by?

A
  • Increased of Methemoglobin in blood
  • Caused by OXIDATIVE damage
  • Oxidation of Hgb Fe 2+ (Ferrous Iron = Fe 2+ ) to Hgb Fe 3+
    (Ferric iron) —> Methemoglobin
  • Methemoglobin
  • has REDUCED capacity to carry O2
  • Dark brown discolored plasma &/or urine
  • When ~30% of Hgb is Methemoglobin
  • Death in Concentration is 90%
45
Q

Methemoglobinemia occurs as a result of

A

Oxidative damage to Hgb
* Onion, garlic
* Acetominaphen (cats)
* Anesthetics (benzocaine)

46
Q

Define hypophosphatemia.
Seen in cats with?
Predisposes patients to?

A

Hypophosphatemia
* Low phosphorus –> decreased glycolysis –> reduced erythrocyte ATP –> hemolysis
* Seen in cats with Diabetes mellitus who are also ketotic
* Hypophosphatemia predispose to Heinz body formation

47
Q

How does Zinc toxicosis result in oxidative damage?

A

Mechanism to induce oxidative damage is unclear
E.g. coins, sunscreen, antidiaper rash cream all have high amounts of zinc.

48
Q

Copper Molybdenum deficiency
* Molybdenum reduces the accumulation of _____ in the liver
* Molybdenum in the feed important risk of copper _________. _______ is an important factor in determining poisoning.
* Copper is a strong ___________ agent and is a protein that binds to _________ and helps store ______.
* When sheep are _______ –> Copper is freed into blood stream –> increased oxidative injury to __________ (Hgb) –> increase erythrocyte ________ and ______ body formation–> intravascular ________ –> Hemolytic _______ as well as?
* Hemoglobin_____
* Hemoglobin_____
*_____ ______ formation

A

Copper Molybdenum deficiency
* Molybdenum reduces the accumulation of copper in the liver
* Copper:molybdenum in the feed important risk of copper poisoning. Ratio is an important factor in determining poisoning.
* Copper is a strong oxidizing agent and is a protein that binds to hepatocytes and helps store iron.
* When sheep are stressed –> Coppers is freed into blood stream –> increased oxidative injury to erythrocytes (Hgb) –> increase erythrocyte fragility and heinz body formation–> intravascular hemolysis –> Hemolytic anemia
* Hemoglobinemia
* Hemoglobinuria
* Heinz body formation

Molybdenum helps reduce accumulation of copper. When ingest high amounts of copper, norally it is in a storage of hepatocytes in ruminants, but once it has accumualte din hepatocyte it is fine. when stressed, copper enters blood whcih increae oxidation ine rythrocytes.

49
Q

How does inherited RBC enzyme defieiciences cause ?

A

Happens in certain breeds of animnals.;

pk deficiency: beagle, basenji, WHWT, carirn terriier; moderate to marked anemia. Find marked reticulocytosis and these aniamks will only live to 4 years of age.

Also see in abyssinian, somali, DSH cats PK deficiency. Anemia presented due to hemolysis.

alkelemia: decrease in H ion concentrtion in blood, changes pH of blood adn icnreases ph in blood. Animals have normaly ot low PCV

Uro III: Animal has anemai due to hemolysis due to decrease in survival time of RBC themselves

Clinical Pathology (31 decks)

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