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Clinical Pathology > Anemia, Pt. 2 > Flashcards

Anemia, Pt. 2 Flashcards

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1
Q

What 2 lab findings point toward non-regenerative anemia?

A
  1. no polychromasia
  2. no or inadequate reticulocytes
    - <80,000/µL (canine)
    - <60,000/µL (feline)
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2
Q

What are 3 causes of non-regenerative anemia?

A
  1. impaired or decreased RBC production by the bone marrow
  2. defective erythrocyte production
  3. too early for regeneration to happen when there is blood loss or destruction
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3
Q

What 6 things cause reduced erythropoiesis to induce non-regenerative anemia?

A
  1. chronic disease causing inflammation (neoplasia)
  2. toxins - Bracken fern, estrogen, radiation
  3. lack of EPO from chronic renal disease, hypoadrenocorticism, or hypothyroidism
  4. immune-mediate pure cell aplasia
  5. infections - FeLV, Anaplasma, Parvovirus, Feline Panleukopenia
  6. myelophthisis - myelofibrosis, myeloproliferative disorders, osteopetrosis, osteosclerosis
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4
Q

What 3 things cause defective erythropoiesis to induce non-regenerative anemia?

A
  1. abnormal maturation congenital in Herefords, English Springer Spaniels, and Poodles; erythremic myelosis, myelodysplastic syndrome
  2. disorders of heme synthesis - chlorampenicol toxicity, copper deficiency, iron deficiency, lead poisoning, molybdenum poisoning, vitamin B6 deficiency
  3. disorders of nucleic acid synthesis - vitamin B12 deficiency, malabsorption, folic acid deficiency
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5
Q

What are 4 causes of non-regenerative anemia?

A
  1. anemia of inflammatory disease/anemia of chronic disease/anemia of inflammation
  2. chronic renal disease
  3. bone marrow hypoplasia/aplasia
  4. nutritional deficiencies
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6
Q

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

A

anemia of inflammatory disease

(anemia of chronic disease, anemia of inflammation)

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7
Q

What are the 3 most common lab findings with anemia of inflammatory disease?

A
  1. mild to moderate anemia
  2. normocytic, normochromic
  3. low serum iron - sequestered in macrophages responding to cause inflammation
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8
Q

What are common infectious and non-infectious causes of anemia of inflammatory disease?

A

INFECTIOUS - chronic infections with Babesia, fungi, viruses, or protozoa

NON-INFECTIOUS - autoimmune disease, toxins, neoplasia

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9
Q

What is multifactorial process of the pathophysiology of anemia of inflammatory disease?

A
  • IL-6 induces hepcidin synthesis, which inhibits iron transport from duodenal enterocytes and macrophages and decreases iron absorption and sequestered iron in macrophages (ferritin stores)
  • decreased erythropoiesis caused by inappropriately low secretio of EPO, decreased response of bone marrow to EPO due to TNFα, low iron
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10
Q

What are 4 possible mechanisms of chronic renal disease causing non-regenerative anemia?

A
  1. decreased EPO production
  2. suppressive effects of uremic toxins on bone marrow
  3. blood loss chronically from GI, skin, and other sites due to qualitative platelet dysfunction due to uremic toxins
  4. shortened RBC survival due to mild hemolysis
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11
Q

What are the 2 common lab findings with chronic renal disease causing anemia?

A
  1. normocytic, normochromic
  2. moderate to severe non-regenerative anemia
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12
Q

What are 4 causes of bone marrow erythroid hypoplasia inducing non-regenerative anemia?

A
  1. FeLV-induced erythroid hypoplasia
  2. pure red cell aplasia
  3. endocrine disorders
  4. immune-mediated
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13
Q

How does FeLV cause non-regenerative anemia?

A

damages or kills erythroid precursors selectively, causing erythroid cells to transform or to become neoplastic

  • erythrocytes are produced, but with defects
  • circulation of abnormal nRBCs
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14
Q

What is the most common lab finding in FeLV-induced erythroid hypoplasia?

A

macrocytic normochromic anemia
- asynchronous maturation of nucleus compared to cytoplasm

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15
Q

How does pure red cell aplasia cause non-regenerative anemia? What is thought to be the mechanism? What are the 2 lab findings?

A

marked hypoplasia or aplasia in the bone marrow decreasing erythroid cells

possible EPO Abs

  1. normocytic normochromic anemia
  2. spherocytes
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16
Q

What 3 endocrine disorders cause non-regenerative anemia?

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A
  1. hypothyroidism
  2. hypoadrenocorticism
  3. hyperestrogenism
17
Q

In what animals are hypothyroidism and hypoadrenocorticism common? What is the most common lab finding?

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A

dogs

normocytic normochromic anemia

18
Q

What commonly masks the anemia in hypoadrenocorticism?

19
Q

What are the most common sources of hyperestrogenism? What are the 3 most common lab findings?

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A

Sertolli cell or ovarian granulosa cell tumors

  1. moderate normocytic normochromic anemia
  2. thrombocytopenia
  3. leukopenia
20
Q

What endocrine disorder commonly has myelotoxicity effects?

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A

hyperestrogenism

21
Q

What is another name for immune-mediated mechanisms of non-regenerative anemia? How does this affect RBCs?

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A

precursor-directed immune-mediated anemia (PIMA)

more immature RBCs than mature RBCs

22
Q

What are 4 lab findings with immune-mediated caused non-regenerative anemia (PIMA)? What is necessary to rule out other causes?

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A
  1. severe normocytic normochromic anemia (HCT <15-20%)
  2. normal WBC and platelets
  3. spherocytes
  4. no polychromasia

bone marrow aspirate

23
Q

What is the most common anemia associated with nutritional deficiencies? How does it develop?

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A

iron deficiency

tends to be regenerative in the early stages, unless it is complicated by anemia of inflammatory disease

24
Q

What lab finding indicates iron deficiency non-regenerative anemia?

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A

microcytic normochromic to hypochromic anemia

25
How does an iron deficiency cause non-regenerative anemia?
cytoplasmic maturation arrest
26
In what animals are copper deficiencies most common? How does it cause non-regenerative anemia? What lab finding suggests this?
pigs, dogs copper is needed to oxidize iron into its ferric phase to allow absorption from enterocytes into the plasma microcytic hypochromic anemia
27
How do folate (B9) and cobalamine (B12) deficiencies cause non-regenerative anemia? This is rare is veterinary medicine, but what breeds has this been reported in?
these are required for DNA synthesis and will cause nuclear maturation arrest when in a deficiency - Border Collies - Beagles - Giant Schnauzers
28
What is the lab finding indicative of folate (B9) and cobalamine (B12) deficiency?
normocytic or macrocytic normochromic non-regenerative anemia
29
What is erythrocytosis? What lab findings suggest this?
increased RBC malls - elevated HCT - elevated RBC count - Hgb in peripheral blood
30
What is relative erythrocytosis? Absolute erythrocytosis?
RELATIVE = physiologic elevated HCT or RBC with respect to plasma caused by hemoconcentration (dehydration, fluid shifts, increased vascular permeability) and physiologic redistribution with excitement and exercise ABSOLUTE = pathologic elevated HCT or RBC caused by caused by bone marrow disorders (primary) or increased erythropoiesis
31
What is the main cause of primary erythrocytosis?
polycythemia vera - neoplasm that causes RBC to have an abnormal close of erythroid precursor capable of proliferating without erythropoietin
32
When does erythropoietin appropriately increase and inappropriately increase to cause secondary erythrocytosis?
APPROPRIATE in chronic hypoxia from cardiac arrest, respiratory disease, or at constant high altitudes INAPPROPRIATE in renal tumors
33
What are 3 common signs of secondary erythrocytosis?
1. increased erythropoietin 2. deep red mucous membranes 3. viscous blood (more RBC mass in circulation)
34
12 y/o Abyssian cat in for a routine annual check:
REMEMBER: Hgb should be 1/3 of HCT ---> there may be a problem with the machine and it is important to remember that Hgb is measured from inside RBCs and free in plasma normocytic non-regenerative anemia - MCHC is inaccurately high due to it being calculated using Hgb cause is most likely hemolysis - more tests necessary to see if it is iatrogenic or intravascular

Clinical Pathology (33 decks)

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