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Lymphoreticular and Haemopoietic > Abnormalities of the Erythron > Flashcards

Abnormalities of the Erythron Flashcards

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1
Q

In which animals are RBCs nucleated?

A

Reptiles and birds

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2
Q

Which animals have elliptical RBCs?

A

Camelids

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3
Q

Where are the sites of RBC production?

A 
Foetus - Liver and spleen
Neonates - Bone marrow
Growing animals - Bone marrow of all bones
Long bones - red/yellow marrow
Flat bones - remain active

Liver and spleen maintain erythropoietic capacity.

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4
Q

What is required for the production of RBCs?

A 
Stem cells
Space in the marrow
Growth factors
Iron
Cholesterol/lipids
Enzymes
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5
Q

How does the nucleus and cytoplasm change during RBC maturation? What are the stage?

A
  1. Rubriblast
  2. Prorubicyte
  3. Basophillic rubricyte
  4. Polychromataphilic rubricyte
  5. Metarubricyte
  6. Reticulocyte

As the cell matures the nucleus becomes more clumpy. Cytoplasm goes from dark to light blue, to orange

Nucleus is then extruded and becomes reticulocytes, which mature to erythrocyte.

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6
Q

What is the life span of erythrocytes in:

a. Dog
b. Cat
c. Horse, cattle

A

a. 100 days
b. 70 days
c. 150 days

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7
Q

How are RBCs usually removed?

A

Major route = senescent red cells taken up by phagocytic macrophages, components recycled.

Minor route = intravascular haemolysis

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8
Q

What is evidence for reduction in red cell mass on biochemistry?

A

Decreased:

  • Haemoglobin concentration [Hgb]
  • PCV
  • Haemtocrit
  • Red blood cell concentration [RBC]
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9
Q

What is haemtocrit?

A

Same as PCV but calculated. Relies on red cell count and volume. Less accurate.

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10
Q

What leads to decreased red cell mass?

A

Increased loss

Decreased production

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11
Q

What are the classes of anaemia?

A

Mild, moderate, severe
Regenerative vs non-regenerative
Normocytic, microcytic, macrocytic
Normochromic, hypochromic, hyperchromic

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12
Q

Describe mild anaemia…

A

Just below - 10% below normal PCV
May not affect animals until exercised
Common in animals with longstanding disease e.g. endocrine

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13
Q

Describe moderate anaemia…

A

May show weakness or be well adapted.
MM pallor, fast bounding pulses
Slow drop = easy to cope with
Fast drop - easily affected and weak

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14
Q

Describe severe anaemia…

A

PCV in lower teens downwards
Pale, weak, unable to exercise
May ned oxygen stabilisation before diagnostics
Don’t fight anaemic cats!

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15
Q

What is the difference between MCH and MCHC?

A 
MCH = (g) Content
MCHC = (g/dL) per volume of fluid i.e. bigger cells needs more haemoglobin
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16
Q

What does a hypochromic red blood cell indicate?

A

Iron deficiency/poor iron incorporation (with microcytosis)

Central pallor increases

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17
Q

Describe normocytic anaemia..

A

Erythrocyte of unremarkable size

Often associated with mild non-regenerative anaemia, acute haemorrhage

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18
Q

Describe macrocytic anaemia…

A

Regeneration - polychromatophils larger than mature RBCs
Seen in poodles
99% macrocytic are regenerative and also hypochromic

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19
Q

Describe microcytic anaemia…

A

Red cell haemoglobin concentration determinds when division stops
Iron deficiency allows an extra division
PSS, Fe, hepatic failure and akitas

If a cell is very pale, they are very thin.

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20
Q

When is macrocytosis of RBCs seen?

A

Regenerative anaemia
FeLV affected cats
In myelodysplasia
Artefact in stored blood

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21
Q

How does the body respond to a fall in oxygen tension?

A
  1. Kidneys respond to low blood O2 by releasing erythropoietin
  2. Stimulates bone marrows to increase RBC production
  3. Takes 2-3 days and younger cells increase in circulation
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22
Q

If it is regenerative, what are the potential causes of anaemia?

A

Haemorrhage

Haemolysis

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23
Q

What is the reticulocyte %?

A

1000 cells counted, reticulocytes expressed as a %

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24
Q

What is the corrected reticulocyte %?

A

Same number of reticulocytes will take up more % in a very anaemic animal

Reticulocyte % x patient PCV/normal PCV

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25
When is the corrected reticulocyte % indicative of regeneration?
When it is >1% in dogs and >0.4% in cats.
26
What is the absolute reticulocyte concentration?
[RBC] x Retic %
27
Causes of external haemorrhage that increases loss of RBCs...
Melena Urinary tract Epistaxis Post-trauma/surgery
28
Describe melena...
Digested blood in faeces GI ulceration/neoplasia - gradual loss of blood not always visible Iron lost forever!
29
Causes of internal haemorrhage that increases losses of RBCs...
``` Bleeding tumours Trauma Into tissues Surgery Body will breakdown RBC outside of vessels and resorb iron ```
30
Causes of haemolysis that increases loss of RBCs
Increased internal RBC destruction Intravascular/extravascular Normal erythrocyte damage
31
Describe IMHA...
Immune mediated haemolytic anaemia Anti RBC antibodies - IgG/M/A Red cells opsonised and either lysed or phagocytosed May aggultinate Coomb's test positive for anti-RBC antibody May be severe/rapid usually strongly regenerative
32
What does RBC agglutination look like on a smear?
Strong bond of RBCs through antibodies | Grape-like clusters that look like flakes grossly
33
What is rouleaux? What does it look like on a smear?
Normal, especially in horses High protein +ve charge stopes RBCs repelling each other Looks like stacked coins
34
How can you distinguish agglutination from rouleaux?
Add saline - the lower the drop in protein conc (dilatation) the less cells will clump together with rouleaux.
35
How can you test for RBC agglutination?
In saline agglutination test One drop of saline and one drop of EDTA mixed on a slide Looks like flecking before it starts to dry if +ve
36
What are ghost cells? | What are they indicative of?
Remnants of RBCs that have lost haemoglobin Complement pokes holes in RBCs and haemoglobin leaks into plasma - a hallmark of intravascular haemolysis Red/pink plasma Membrane only
37
What are spherocytes? | What are they indicative of?
Round, dark and dense cell with no central pallor 99% certain it is IMHA Extravascular haemolysis - macrophages bite chunks out of RBCs and if it survives it becomes spherocyte.
38
What lab findings are associated with IMHA?
Regenerative anaemia Increased bilirubin Neutrophilia, monocytosis Platelets may be affected
39
Which parasites cause haemolysis?
Mycoplasma haemofelis and M. maemominutum Blood borne and increases fragility and haemolysis Either destroys the cell itself or immune system destroys cell because of parasite Babesia
40
What does mycoplasma haemofelis look like on a smear?
Small rings on red blood cell surface
41
How can you diagnose mycoplasma haemofelis?
PCR - gold standard | Blood smear
42
What are heinz bodies? | Are cats or dogs more susceptible?
Denatured haemoglobin Due to oxidative damage e.g. onions, paracetamol, vit K, propylene glycol Cats >dogs Low numbers is normal in cats
43
What are eccentrocytes?
Haemoglobin has uneven distribution within the RBC Oxidative damage to membrane Dogs >cats Horses with red maple toxicosis
44
What does it mean if you see lots of eccentrocytes?
Damage has occurred recently/occuring now because they are quickly removed from the circulation
45
What are the products of shear injury?
Shistocytes Keratocytes Accompany microangipathic damage (vasculitis/tumours narrowing vessels) as causes RBC damage when passes through
46
What are acanthocytes?
Uneven surface projection from RBCs | Associated with splenic disease e.g. haemangiosarcoma
47
What are keratocytes?
RBC with apposed and sealed membrane Helmet shaped Associated with shearing e.g. DIC, vasculitis Seen with schistocytes
48
What are schistocytes?
RBC fragments occur secondary to shear injury | Associated with fibrin deposition in vessels and DIC
49
What inherited diseases cause abnormal RBCs?
Pyruvate kinases deficiency - Chronic - Severe haemolysis - Initially regenerative the myelofibrosis and die 1year - Basenjis and beagles Phosphdructokinase deficiency - RBC sensitive to alkaline pH - Low grade haemolysis with severe episodes - Springers
50
What is the most common cause of non-regenerative anaemia?
Anaemia due to inflammatory/chronic disease.
51
Describe the usual presentation of anaemia of chronic disease....
Non-regenerative Normocytic, normochromic Mild, slow progressing Fe sequestration, inflammatory mediators, shortened erythrocyte survival
52
Describe renal non-regenerative anaemia...
Decreased erythropoeitin production Normocytic, normochromic Impacts QOL
53
How can you treat renal non-regenerative anaemia?
Erythropoietin injections available but may develop Ab and wipe out own erythropoietin Aim to increase PCV, not back to normal
54
Describe endocrine non-regenerative anaemia...
Hypothyroidism and hypoadrenocorticism Normocytic, normochromic Mild Thyroid hormone and cortisol facultative effect on RBC production
55
Describe non-regenerative anaemia caused by FeLV
``` 70% of anaemic cats Selective depression of erythropoeiesis Dysplasia production Myeloproliferative disease vrowding out Normochromic normocytic but many are macrocytic ```
56
Describe non-regenerative marrow... | What can cause it?
All precursors wiped out (aplasia anaemia) Fat, plasma cells, mast cells left Need core biopsy ``` Causes: FeLV Oestrogen toxicity Phenylbutazone Chemotherpay Unknown ```
57
What is myelodysplasia? What would you see in the marrow?
Adequate cellularity in marrow but abnormal maturation/production of cells ``` Marrow: Erythrocyte macrocytosis Binucleate Maturation defects Giant neutrophils Hyper segmented neutrophiles Macroplatelets May go onto leukaemia ```
58
What is the difference between leukaemia and myelodysplasia?
Leukaemia - lots of cells produced that enter the bloodstream Myelodysplasia - lots of abnormal cells produced that don't survive in the blood stream
59
Why do neoplastic conditions of the bone marrow causes anaemia?
Non-regenerative due to crowding of the bone marrow Altered environment Usually haemopoeitic neoplasms
60
What is myelofibrosis?
Fibrosis of the bone marrow = response to injury Osteosclerosis - cortical bone increases May get marked extra-medullary haematopoiesis
61
When does iron deficiency anaemia become non-regenerative?
Chronic cases - bone marrow runs out of iron (can usually cope for a few months)
62
When does immune mediated anaemia become non-regenerative?
Immune mediated attack on precusors, non peripheral RBCs
63
What is erythrocytosis (polycythemia)?
Increases in HCT, RBC count and haemoglobin
64
What are the causes of erythrocytosis (polycythemia)?
Splenic contraction Neoplasm Dehydration Increase production e.g. altitude/neoplasm
65
Describe primary erythrocytosis...
Myeloproliferative disorder or erythroid stem cells EPO normal or decreased PO2 normal
66
Describe secondary erythrocytosis
Appropriate or inappropriate Chronic hypoxia e.g. altitude EPO secreting tumours EPO levels elevated

Lymphoreticular and Haemopoietic (14 decks)

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