Non-Regenerative Anemia

Question 1

What is indicative of regeneration?

Answer 1

reticulocytosis above the RI or >60,000/uL

Question 2

What is the most common cause of non-regenerative anemia?

Answer 2

anemia of chronic disease

• mild to moderate

Question 3

What endocrine diseases and nutritional deficiencies most commonly cause non-regenerative anemia?

Answer 3

hypothyroidism, hypoadrenocorticism, estrogen (BM toxicity)

iron, vitamin B12, folate

Question 4

How does bone marrow disease causing anemia present on blood work? What are the most common causes?

Answer 4

normocytic, normochromic, non-regenerative

• infections - Ehrlichiosis, FIV, FeLV
• toxins, drugs - chemotherapy, estrogen
• immune-mediated - destruction of precursors
• marrow neoplasia
• myelodysplasia, myelofibrosis

Question 5

What are the most common causes of microcytic, hypochromic / macrocytic, normochromic non-regenerartive anemia?

Answer 5

MICROCYTIC, HYPOCHROMIC - chronic blood loss, iron deficiency, portosystemic shunt (anemia uncommon/mild)

MACROCYTIC, NORMOCHROMIC - FeLV, folate and cobalamin deficiencies

Question 6

What kind of anemia is caused by chronic disease? How long must disease be present? What are clinical signs dependent on?

Answer 6

mild to moderate (25-36%) normocytic, normochromic, non-regenerative anemia

• CATS =1 week
• DOGS = 2 weeks

related to primary disease, not typically related to anemia

Question 7

How does chronic renal failure cause anemia? What kind anemia is most commonly seen?

Answer 7

• decreased renal EPO production*
• decreased RBC lifespan
• impaired response to EPO
• GI loss

moderate to severe (20%) normocytic, normochromic non-regenerative anemia

Question 8

How is anemia of chronic renal failure treated?

Answer 8

• EPO
• Darbopoietin
• Varenzin-CA1 (cats)

Question 9

What is the most common cause of iron deficiency anemia? What kind of anemia is seen?

Answer 9

blood loss —> parasites, GI hemorrhage, epistaxis, hematuria

microcytic, hypochromic, non-regenerative

Question 10

How is iron deficiency anemia most commonly diagnosed? Treated?

Answer 10

identification of blood loss

• iron supplementation +/- transfusion
• stop bleeding (deworming, pressure, etc.)

Question 11

How can bone marrow disease causing anemia be differentiated from IMHA or ITP? How is it diagnosed?

Answer 11

• bone marrow disease = other cell lines, like WBCs and platelets affected, non-regenerative!
• IMHA, ITP = hemolysis, regenerative!

bone marrow aspirate or biopsy

Question 12

What is immune-mediated non-regenerative anemia (PIMA)? What is seen in the bone marrow?

Answer 12

immune response against RBC precursors in the bone marrow, causing severe non-regenerative anemia +/- positive Coomb’s and hemolysis

• no erythroid precursors present
• arrest at a specific stage of RBC maturation

Question 13

How is immune-mediated non-regenerative anemia (PIMA) diagnosed? Treated?

Answer 13

• exclude other causes, like neoplasia
• bone marrow appearance on biopsy (decreased precursors!)

immunosuppression (Prednisone + second line options)

Question 14

What is aplastic anemia? What are the 3 most common causes? How is it diagnosed?

Answer 14

failure of the bone marrow resulting in all cell lines (pancytopenia)

1. infections - FeLV, Ehrlichiosis
2. drugs - chemotherapeutics, adverse reaction
3. estrogen - human meds/creams, USMI treatment

bone marrow aspirate/biopsy - no RBC, WBC, or platelet precursors

Question 15

What is myelodysplasia? What is it most commonly secondary to?

Answer 15

abnormal development of one or more hematopoietic cell lines, commonly a precursor to hematopoietic neoplasia

• FeLV in cats
• immune-mediated disease

Question 16

What are the 4 most common infectious causes of non-regenerative anemia?

Answer 16

1. Ehrlichia
2. FeLV +/- Mycoplasma hemofelis
3. Histoplasmosis (fungal)
4. septicemia - leukopenic, anemic

Question 17

How does FeLV cause hematologic disorders? What. ismost commonly seen? What is less commonly seen?

Answer 17

infects bone marrow elements

non-regenerative anemia —> red cell aplasia with lack of early erythroid precursors = severe macrocytic anemia +/- dysplasia

aplastic anemia —> pancytopenia due to lack of all cell line production

Question 18

What 3 neoplasias most commonly cause non-regenerative anemia?

Answer 18

1. leukemia
2. multiple myeloma
3. malignant histiocytosis - disseminated histiocytoma = increased histiocytes or macrophages that destroy BM precursors

Question 19

What is myelofibrosis? How is it diagnosed?

Answer 19

proliferative response of bone marrow fibroblasts, replacing BM with fat and connective tissue, typically idiopathic or in response to injury —> BM necrosis = non-regenerative anemia

bone marrow biopsy > aspirate - gives a larger picture

Question 20

What is indicative of a proper bone marrow aspirate or biopsy sample?

Answer 20

marrow particles and megakaryocytes

Question 21

Classify the anemia:

Answer 21

severe, normocytic, hypochromic, non-regenerative