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Anaemia Flashcards

1
Q

Define anaemia

A

Reduction in the erythron mass based upon PCV (Htc), haemoglobin and RBC count

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2
Q

What is the clinical consequence of anaemia?

A

Inadequate oxygen carrying capacity in the blood

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3
Q

What is the physiological response to anaemia?

A
  • Increased RBC 2,3-DPG - lowers Hb-o2 affinity - allows better o2 delivery to peripheral tissues
  • Cats - Variety of Hbs which have different o2 affinities
  • Increased EPO - alters tissue perfusion
  • Behaviour alteration
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4
Q

What are the physiological causes of anaemia?

A
  • Increased RBC loss
  • Increased RBC destruction - IMHA
  • Inadequate bone marrow production of RBC
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5
Q

What clinical signs are associated with anaemia?

A
  • Pallor/ weakness
  • CRT
  • Tachy and bounding/weak pulses
  • Tachypnoea, dyspnoea
  • Haemic murmur - results from low blood viscosity
  • Jaundice
  • Petechia
  • Pyrexia
  • Lymphandenopathy
  • Abdominal pain
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6
Q

Outline the normal response to decreased O2.

A

Reduced O2 levels in the blood EPO release from the kidney Stimulates Red bone marrow to produce RBCs Increased O2 carrying capacity of the blood

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7
Q

What is regenerative anaemia?

A

The regenerative response is due to the bone marrow trying to compensate increasing erythropoiesis by releasing juvenile RBCs (reticulocytes)Leads to polychromasia

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8
Q

What is meant by pre-regenerative?

A

A smear visualised before the release of reticulocytes has taken place - need 3-4 days before seeing an increase in juvenile RBCs

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9
Q

What is non-regenerative anaemia?

A

When the bone marrow is unable to compensate due either to primary bone marrow disease or no endocrine (EPO) response to reduced O2 carrying capacity

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10
Q

At which days post insult is the regenerative response at its peak?

A

4-7 daysCharacterised by polychromasia and reticulocytes

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11
Q

What is the difference between an aggregate and punctate reticulocyte?

A

Aggregate contain large amounts of RNA and last only 24 hours.Punctate contain small amounts of RNA and last up to 10 days.

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12
Q

Which type of reticulocyte reflect current/ ongoing regenerative response in cats?

A

Aggregate

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13
Q

What is the observe response to acute haemorrhage?Describe and explain the haemocrit values observed immediately following haemorrhage and 24 hours later.

A
  • Proportional loss of all blood components, fluid moves into the vascular space, decreased PCV and TP Hct
  • Immediately - PCV 45% due to compensatory splenic contraction
  • 24 hrs - PCV 40% due to interstitial fluid moving into the vascular space
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14
Q

How would an animal with acute haemorrhage present in practice?

A

Would present as hypovolaemic shock:

  • Pallor
  • Tachycardia
  • Weak peripheral pulses Poor peripheral perfusion
  • > CRT
  • Cold extremities
  • Increased lactate
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15
Q

What finding is most suggestive of acute blood loss as a cause?

  • Hypochromasia and microcytosis on smear
  • Decreased TP
  • Thrombocytopenia
  • Polychromasia
  • Decreased MCHC
A

3

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16
Q

How can chronic blood loss lead to iron deficiency anaemia?How is IDA characterised on a blood smear?

A

Leads to consumption of irons stores.

  • Hypochromasia
  • Microcytic RBCs
  • May be regenerative (once erythropoiesis slows) or non-regenerative
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17
Q

How long does it take for IDA to develop in adults and why?

A

Takes about one month of chronic bleeding to develop due to abundant stores of iron in adults

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18
Q

What is the most common cause of IDA?

A

GI haemorrhage - may be due to NSAIDs, steroids, neoplasiaCan also be:

  • Urinary
  • Skin
  • Resp
  • Congenital defects
  • Parasitic infestations
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19
Q

How can IDA be treated?

  • Treating IDA
  • Treating underlying GI haemorrhage
A

IDA

  • Blood transfusion
  • Iron supplementation - oral ferrous sulphate, IM iron dextran GI haemorrhage
  • Sucralfate - acid buffer
  • H2 antagonist
  • H+ pump inhibitor
  • PGE analogue
20
Q

IMHA

A

Production od Abs against RBCs.Causes haemolysis and removal by macrophages and complement

21
Q

How does extravascular haemolysis cause jaundice?

A

Bilirubin is produced in haemolysis of RBCs.It is conjugated by the liver and excreted with bile.If liver capacity is overwhelmed hyperbilirubinaemia occurs leading to jaundice

22
Q

How does intravascular haemolysis lead to haemoglobinuria/ jaundice?

A

Haemoglobinuria

  • Free haemoglobin in the vascular space
  • Haptoglobin saturation
  • Hb dissociates in dimers which passes freely through the kidneys Jaundice
  • Free Hb
  • Binds haptoglobin and metabolised in the liver
  • If liver is overwhelmed = jaundice
23
Q

Which RBC shape abnormality is strongly supportive of IMHA?

A

SpherocytesDue to macrophage pitting the membrane portion which contains the Ab-Ag complex.

24
Q

Cell ghost

A

Very pale staining RBCs which are indicative of direct membrane damage by complement

25
What is cold agglutinin disease?
An autoimmune disease characterized by the presence of high concentrations of circulating antibodies, usually IgM, directed against red blood cells.Leads to: * Capillary blockage * Ischemia * Extremity necrosis
26
What is the Coombs test?
Test for IMHAAn antiglobulin test
27
Which tests are used in diagnosis of IMHA?
* Clin signs Haematology * Autoagglutination - RBC grape clusters - persists if RBCs are washed  * Regeneration * Spherocytes * Leukocytosis * Positive coombs test - used with caution - tests for Ab and complement
28
What situations can cause false positive and false negative results from a coombs test?
False positive * Previous blood transfusion * Bystander complement and Ab effect Negative * Antisera at wrong concentration * Glucocorticoid therapy
29
Name three haemic parasites.
* Mycoplasma haemofelis * Anaplasma * Babesia * Ehrlichia
30
Outline a treatment plan for IMHA.
``` Immunosupression * Corticosteroids * Cytotoxics - azathioprine * Cyclosporin Start the dose high and gradually reduce to effect (two weeks between dose reductions - may be on treatment for life ```
31
How do corticosteroids reduce IMHA?
Reduction in Fc receptor mediated RBC destructionInhibits complement activationReducing circulating cytokines
32
Outline five side effects which may result from corticosteroid use.
* PUPD * Polyphagia - obesity * Muscle wastage, poor exercise tolerence Gi  * gastritis * ulceration * pancreatitis * Other organ damage long term
33
What is the mechanism of action of azathioprine and Cyclophosphamide?
* Suppress T cell and dependent B cell responses (from helper T cells) * Reduce lymphocyte numbers * Reduced Ab production * Affects macrophage function - cyclo
34
How does cyclosporin work?
* Suppressed CMI | * Secondary reduction in Ab production
35
Neonatal isoerythrolysis
Destruction of neonatal erythrocytes by materal antibody
36
IMHA may be associated with all, except... * IDA * Thromboembolic disease * DIC * Hypoxia & hypoperfusion * Neutrophilia and left shift
5 - associated with monocytosis and left shift
37
Mechanical damage/ fragmentation as RBCs pass through fibrin meshwork in microvasculate.
Microangiopathic haemolysis
38
How can mechanical damage to RBCs occur in the vasculature?
* Altered vasculature - haemangiosarcoma * Fibrin nets - DIC * Glomeronephritis * Congenital defects
39
Which RBC shape abnormalities are typical of microangiopathic haemolysis?Describe each.
Schistocytes * fragmented RBCs  Acanthocytes * rounded projections of variable length from the RBCs surface
40
Oxidative damage of RBCs occurs due to...The disease process results in..
Increased free radicals in the blood leading to cell damage * Heinz body formation - denatured Hb within RBCs * Methaemoglobinaemia * Membrane oxidation
41
What is a Howell Jolly body?
A nuclear remnant - NOT indicative of oxidative damage
42
Intoxication of which substance in cats can lead to oxidative damage..
Paracetamol
43
What can cause non-regenerative anaemia?
Primary marrow disease Drug reaction * NSAIDS, phenobarb, oestrogen (endo/exog) * Neoplasia * Pure red cell aplasia - immune mediated * A plastic anaemia * Lack of EPO - renal disease
44
Describe anaemia of chronic kidney disease.
* Normocytic * Normochromic * Non-regen * Reduced EPO * Haemorrhage * Reduced red cell survival/ erythropoiesis
45
Outline some infectious causes of anaemia.
* Feline retroviruses - FeLV, FIV Rickettsial  * Ehrlichia * Leishmania * Babesia * Mycoplasma haemofelis

Clinical pathology (7 decks)

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