What are 3 causes of anemia?
Increased loss
Increased destruction
Decreased production
What is anemia?
Decreasee in RBC mass
What does anemia result in?
Decreased oxygenation
How is red cell mass measured? (3 things)
PCV
RBC count
Hemoglobin concentration
What are the 5 main clinical signs you see in an anemic patient?
Pale MM Lethargy Increased RR Increased HR Murmurs (if < 20%)
What can non-specific clinical signs be related to in cases of anemia?
Underlying illness
T/F: Anemia is a diagnosis.
False, anemia is a lab finding. Cause of anemia is the diagnosis.
What are 3 clinical signs associated with blood destruction?
Splenomegaly
Icterus
Hemoglobinuria
What does severity of clinical signs of anema correlate to?
Duration of onset.
How severe is slow onset anemia?
Less severe
How severe is fast onset anemia?
More severe
What are the 3 main diagnostic approaches to anemia?
Lab evaluation
History
Physical exam
What are the 4 main lab evals for anemia?
PCV
MCV
Retic. count
TP
What else should you expect to see in acute blood loss?
Total protein decrease
How do you read a cytogram?
Large cells on top, small cells on bottom
Hypochromic cells to the left, hyperchromic cells to the right
How do you read a histograms?
Small cells are to the left, large cells are to the right
What are 2 other types of lab tests you can run with anemia?
Tests for specific types of anemia
Biochem profile
What is an example of a test for a specific type of anemia? (2 things)
Serum iron
Coomb’s test
What can a biochem profile detect? (1 thing)
Renal failure
What other tests might you run on a cat with a non-regenerative, macrocytic anemia?
FIV test
In acute blood loss, what two things decrease together?
PCV and protien
In acute blood loss, what is RBC morphology like? What is an exception?
Normal
Hemangiosarcoma in a dog
What RBC morphology can mean hemangiosarcoma?
Acanthocytes
What are 4 examples of acute blood loss?
Trauma/Surgery
Coag. disorders
Bleeding tumors
Thrombocytopenia
T/F: Blood loss causes a thrombocytopenia.
False. Blood loss does NOT cause a thrombocytopenia, however thromobocytopenia does cause blood loss.
What are 3 examples of chronic blood loss?
GI Ulcer
Bleeding GI tumor
Blood consuming parasites
What is the most common site for chronic blood loss?
Intestines
What causes iron deficiency anemia in nursing animals?
Inadequate intake
What causes iron deficiency anemia in adults?
Almost always chronic blood loss
What type of anemia (micro/macro) is iron deficiency anemia?
Microcytic
What do we find with reticulocytes in iron deficiency anemia?
Decreased MCV
What do we see in the RDW in iron deficiency anemia?
RDW is increased (anisocytosis)
What dowe see in the MCHC in iron deficiency anemia?
Usually normal
What two RBC morphologies might we see with iron deficiency anemia?
Keratocytes
Increased zone of central pallor
Is iron deficiency anemia usually regenerative or non-regenerative?
Regenerative
What is also common in iron deficiency anemia?
Thrombocytosis
What 3 things will decrease with iron deficiency anemia?
Serum iron
Transferrin saturation
Decreased storage iron
What 3 things will you see to give an iron deficiency anemia diagnosis?
Anemia
Low serum iron
Microcytosis
How can platelets throw off a RBC count?
If they’re big enough or clumped, can be counted as RBCs.
What is the treatment in neonates with iron deficiency anemia?
Injectable iron
Why wouldn’t you give oral iron to neonates with iron deficiency anemia?
It’s toxic and their livers can’t handle it yet.
What is the treatment in adults with iron deficiency anemia?
Find the cause of the iron deficiency and source of blood loss.
What are 3 causes of microcytosis?
Portosystemic shunts Breed dispositon (Asian breeds) Anemia of inflammatory disease (rare in dogs)
In dogs why are anemias of inflammatory disease usually normocytic?
Because they have increased storage iron.
What are the two types of hemolysis?
Intravascular
Extravascular
What is the most common cause of RBC destruction in cats?
Heinz body anemia (think Heinz CATsup)
On top of general signs of anemia, what else might you see with blood destruction? (4 things)
+/- Splenomegaly
+/- Hyperbilirubinemia
+/- Hemoglobinemia
+/- Hemoglobinuria
What will you see with total protein in cases of blood destruction?
TP will be normal
IMHA is often..?
Secondary to other disorders
What are some disorders that can cause IMHA? (4 things)
Infection
MLV vaccine
Neoplasia
Drugs
What 3 things is IMHA associated with in horses?
Penicillin
Clostridials
Neoplasia
What 3 things is IMHA associated with in cats?
Mycoplasma haemofelis
FeLV
Neoplasia
What species is IMHA most common in?
Dogs
What are the top 3 dog breeds for IMHA?
Cocker Spaniels
Poodles
Collies
What dogs (not breed) are most at risk for IMHA?
Middle aged to old females
What test can be done to determine if IMHA is present?
Coombs’ Test
What are the two main disadvantages of the Coombs’ test?
Many false positives
Many false negatives
What is the reason for a false positive Coombs’ test?
Immune complexes attached to RBCs, but destruction isn’t increased.
What is the reason for a flase negative Coombs’ test?
Low concentration of Ab on RBCs
When is the Coomb’s test not indicated?
When agglutination is present.
What are 3 major lab findings in IMHA cases?
Throbocytopenia (maybe)
Inflammatory leukogram
Azotemia (maybe)
What are 2 reasons that you would see thrombocytopenia with IMHA?
Immune-mediated
DIC
What is the term for IMHA with thrombocytopenia?
Evan’s Syndrome
What is the cause for azotemia with IMHA?
Increased creatinine and BUN from RBC destruction
What are 5 differentials for spherocytes?
Previous mismatched blood transfusions Rattlesnake envenomation Heinz body anemia of horses Zinc toxicosis Bee stings
What two things cause eccino-spherocyte cases?
Zinc toxicosis
Bee stings
What are mortality rates when you see spherocytes?
25-50%
What do animals with spherocytes usually die from?
Thromboembolism
How do you treat IMHA? (3 things)
Glucocorticosteroids
Fluids
Correct acidosis
How do glucocorticosteroids help treat IMHA? (3 things)
Decrease Ab production, T-cell activity and macrophage function
What two things are not indicated in IMHA cases?
Blood transfusion (unless anemia is life threatening) Splenectomy
Why is a blood transfusion not indicated in IMHA cases?
Adds fuel to the fire.
Is IMHA usually regenerative or non-regenerative?
Regenerative
What two things will you always see with IMHA?
Spherocytosis
Neutrophilia with left shift
What two things MIGHT you also see with IMHA?
Agglutination
Thrombocytopenia
What shape changes do you see with rattlesnake envenomation in dogs?
Spheroechinocytosis
NOTE: Spherocytes may remain after echinocytic changes have reversed.
What shape changes do you see with clostridial infections in horses?
Spherocytes, spheroechinocytes and type 3 echinocytes
What is the cause of Heinz body anemia in horses?
Membranes collapse after eccentrocyte formation OR
Heinz body formation results in band 3 clustering.
What is band 3?
A protein that changes bicarbonate for chloride, increased RBC capatiy to carry CO2
What does bee venom contain and what does it do?
Mellitin.
A band 3 clustering agent and phsopholipase
What does zinc toxicosis do?
Results in band 3 clustering
What is neonatal isoerythrolysis?
Maternal Abs against the neonates blood group = hemolysis
What species is neonatal isoerythrolysis most common in?
Horses and mule foals
How do most RBC parasites cause anemia?
By immune mediated mechanisms
What two RBC parasites cause intravascular hemolysis?
Babesia
Theileria
What two ways do you diagnose RBC parasites?
Blood film (old fashioned) PCR assay (more accurate)
What RBC parasite is a common, serious cause of severe anemia?
Mycoplasma haemofelis
How is Mycoplasma haemofelis transmitted? (2 ways)
Infected blood
Vertical transmission
What are clinical signs of Mycoplasma haemofelis? (4 things)
Signs of anemia: Splenomegaly Fever Lethargy Sometimes icterus
What can predispose animals to M. haemofelis? (3 things)
Concurrent disease
Immunosuppression
Splenectomy
Is anemia caused by M. haemofelis a regenerative, or non-regenerative anemia?
Regenerative UNLESS underlying disease (eg. FeLV, or severe inflammatory disease)
NOTE: FeLV and FIV titers would be indicated here.
How do you treat M. haemofelis? (4 things)
Transfusion (if anemia is severe)
Prednisone to supress RBC destruction
Doxycycline for 3 weeks
Enrofloxacin IF problems with Doxy
T/F: Cats remain carriers of M. haemofelis?
True
When do you most often see M. haemofelis? (2 things)
Usually only in splenectomized or severely immunosupressed dogs
What clinical signs do you see with M. haemocanis?
Signs of anemia (my look like IMHA)
What do you use to treat M. haemocanis?
Doxycycline
What species is infected my M. wenyonii?
Cattle
What do you see in cattle infected with M. wenyonii?
Severe anemia, but ONLY if splenectomized or immunosuppressed.
How is M wenyonii commonly transmitted?
Iatrogenic transmission
What MIGHT M. wenyonii cause? (2 things)
Dependent edema
Lymphadenopathy
Both without anemia
What are two important points about M. haemolamae?
Opportunist
Causes mild anemia
What does M. haemosuis cause severe anemia in?
Baby pigs
What does M. haemosuis cause in adult pigs?
Poor weight gain
How do you treat M. haemosuis in baby pigs?
Usually treated with one dose of long acting oxytetracycline
What two anaplasmas do you see in ruminants?
A. marginale
A. centrale
How is anaplasma transmitted and what is it’s distribution?
Tick-borne
Worldwide
What can anaplasma cause, especially in older animals?
Fatal hemolytic anemia
How does anaplasma cause the anemia?
Probably immune mediated destruction
T/F: A vaccine is available for anaplasma.
True
What do you treat anaplasma with?
Tetracycline
What two types of babesia do you see in dogs?
B. canis
B. gibsoni
What two typess of babesia do you see in cattle?
B. bovis
B. bigemina
What two types of babesia do you see in horses?
B. equi
B. caballi
What is another name for babesia in horses?
Piroplasmosis
What two types of babesia do you see in cats?
B. cati
B. felis
How is babesia transmitted? (3 things)
Ticks
Blood transfusions
Vertically
What does babesia cause? (2 things)
Severe disease and hemolytic anemia
What might babesia be mistaken for?
IMHA
T/F: Dogs that survive usually become chronic carriers of babesia.
True
What is theileriosis?
A protozoa
What does Theileria cause in ruminants?
Hemolytic anemia
What is another name for Theileria parva?
East Coast Fever
What stage of Theileria do you see in RBCs?
Merozoite
What kind of in vitro shape change can you see in deer blood?
Sickle shape RBCs
What causes feline cytauxzoonosis?
A protozoa
How is feline cytauxzoonosis transmitted?
Ticks
T/F: Feline cytauxzoonosis is rarely fatal.
False, it’s almost always fatal.
What causes Heinz body anemia?
Oxidative denaturation of hemoglobin
What species is most susceptible to Heinz bodies?
Cats
What 3 diseases do you often see Heinz bodies with?
Lymphoma
Hyperthyroidism
Diabetes mellitus
Many drugs that cause Heinz body anemia also cause..?
Methemoglobinemia
What 3 families of plants cause Heinz body formation?
Allium family (onions, garlic) Brassica (kale, cabbage, rape) WILTED red maple leaves
What drug causes Heinz bodies?
Acetaminophen
What are two ways that Heinz bodies are formed?
Hemichrome formation due to oxidative damage
Sulfhydral groups susceptible to oxidative damage (cats have 8 groups)
What might you see with clustering of protein band 3?
Spherocytes
How doe Heinz bodies elicit an anemia?
RBC membrane is more rigid, making them more susceptible to removal by macrophages or lysis
What is methemoglobinemia?
Iron is in ferric state and can’t carry oxygen
What causes methemoglobinemia in cats?
Acetaminophen toxicity
What causes methemoglobinemia in cows?
Nitrate poisoning (from rumen bacteria)
What causes methemoglobinemia in horses?
Red maple leaf ingestion
What can cause methemoglobinemia?
Congenital deficiency of NADH-methemoglobin reductase
What causes excessive formation of methemoglobin?
Oxidative damage
What two things are caused by oxidative damage?
Methemoglobinemia
Heinz bodies
What percentage of methemoglobin concentration results in the blood appearing chocolate brown?
30%
What percentage of methemoglobin concentration causes death?
90%
How can ou treat methemoglobinemia?
Methylene blue to reduce to deoxyhemoglobin
What species is susceptible to copper toxicosis?
Sheep
Where does copper accumulate in copper toxicosis?
In the liver
What 4 things do you see in the blood with copper toxicosis?
Hemolytic anemia
Hemoglobinemia
Hemoglobinuria
Heinz body formation
What does low phosphorus cause?
Decreased glycolysis
What does low phosphorus in cattle cause?
Postparturient hemoglobinuria
What does low phosphorus cause in cats?
Diabetes mellitus
What in cats can cause hypophosphatemia?
Enteral alimentation
What causes hemolytic anemia (“yellow disease”) in lambs and calves?
C. perfringens Type A
What bacteria causes bacillary hemoglobinuria in cattle?
C. haemolyticum
What is another name for bacillary hemoglobinuria?
Red water disease
What is bacillary hemoglobinuria/red water disease associated with?
Liver fluke migration
What clinical signs do you see in cattle with C. haemolyticum? (6 things)
Anemia Arched back Bloody diarrhea Fever Dyspnea Hemoglobinuria
What species does water intoxication occur in?
Cattle (usually calves)
How does water intoxication happen?
Cattle are given unlimited access to water after it’s unavailable for a while.
How does water intoxication lead to hemolysis?
Decreased osmolality (water increases too fast) of plasma.
What can make water intoxication more severe?
Iron deficiency anemia
What virus induces hemolysis?
Equine infection anemia “Swamp fever”
What are 4 inherited RBC membrane defects?
Spherocytosis
Elliptocytosis
Stomatocytosis
Membrane transport defects
What dog breeds show pyruvate kinase deficiency? (4 things)
Basenji
Beagle
Westies
Cairn terriers
What signs do you see with pyruvate kinase deficiency? (5 things)
Moderate to marked anemia Marked reticulocytosis Myelofibrosis Sclerosis Death by age 4
What cat breeds show pyruvate kinase deficiency? (3 things)
Abyssinian
Somali
DSH
What do you not see in cats with pyruvate kinase deficiency?
Osteosclerosis, cats can live to old age
What dog breed do you see phosphofructokinase deficiency in?
English Springer Spaniel
What clinical signs do you see with phosphofructokinase deficiency?
PCV will be normal to low normal
Will see hemolytic crisis when alkalemic
What causes porphyria?
Deficiency of uroporphyrinogen III co-synthetase
What is porphyria?
An inability to synthesize hemoglobin
What are clinical signs of porphyria? (3 things)
Pink teeth and bones
Photosensitivity
Decreased RBC survival
What’s special about porphyria in pigs?
No photosensitization
What’s special about porphyria in cats?
No anemia