Chapter 5 - Regenerative anemia and tests Flashcards by Jessica Buchy

If hemolysis is occuring in the spleen what do you expect to see on blood film

spherocytes

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If hemolysis is occuring in the blood vessels what do you expect to see on blood film

ghost cells

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__ undergo extravascular or intravascular hemolysis bc of their rigidity and fragility.

spherocytes

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RBC coated with __ undergo extravascular hemolysis by macrophages and are conveverted to spherocytes

surface-associated Ig and/or complement protein 3

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Some RBC surface IgM may bind complement which activates the complement cascade and leads to intravascular hemolysis via the __

membrane attach complex (MAC attach)

complex of complement factors 5b through 9

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damaged cells are removed from circulation by

macrophages

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7 lab findings for IMH

Regenerative anemia (usually) - polychormatophils, howell jolly bodies
macro or microagglutination
Spherocytosis
Neutrophilia
pigmentemia/uria
variable platelets
abnormal liver enzymes

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__ test is used to distinguish rouleaux from autoagglutination. It should be ran at __ temperature.

saline, Body

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microagglutination looks like __ where rouleaux looks like __

grapes, stack of coins

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what animals normally have rouleaux RBC

Cats, horses, pigs, bovides

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how will you treat autoagglutination

steroids (do not treat rouleaux usually)

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__ is the nonspecific binding of RBC due to high blood protein

rouleaux (do not treat)

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__ is the specific binding of RBC by Ab seen in IMHA

agglutination (treat with steroids)

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what animals are spherocytes difficult to ddx and other tests need to be preformed

cats and horses, less central palar

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__ can occur due to inflammation or infection, seen with IMHA

Neutrophilia (high neutrophil count)

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2 types of Primary IMHA

idiopathic auto-immune hemolytic anemia (AIMA)

neonatal isoerythrolysis

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most common ddx IMHA

idiopathic AIHA

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most commonly IMHA is __

secondary

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__ is common in horses and can happen in cats but is rare in small animals

neonatal isoerythrolysis

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First steps when suspecting p with IMHA

Get a good history, test for underlying causes

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what are 4 class of infectious dz that can cause secondary IMHA

RBC parasite (babesia, hemoplasma)
Tick borne dz (anaplasma)
virus (FeLV, EIA)
bacterial infection anywhere

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chemicals that can cause secondary IMHA

Drugs, vaccines, toxins

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type of neoplasia that causes secondary IMHA

Lymphoma

other Immune mediated dz such as __ can cause secondary IMHA

systemic lupus erythematosus (SLE), IM thrombocytopenia, others

what are some common tests used to work-up an IMH case

1. good history (vx, ticks, travel, drugs, etc) 2. ddx imaging 3. serology (Ab against infectious dz present) 4. PCR (and infectious dz DNA present) 5. cultures (test fluid/tissue samples for infectious dz) 6. coomb's test 7. erythrocyte osmotic fragility (cats)

__ is done when anemic animals exhibit signs of hemolysis and there is clinical suspicion that the hemolysis may be caused by autoimmune dz

Coombs' test (if have autoagglutination do not have to do this test)

Coombs' test is used in cases when there is evidence of hemolysis but __ is abscent

autoagglutination

What is the purpose of a coombs' test

detect immune system proteins on p RBCs

What are 2 tests to ddx IMHA

autoagglutination or coombs' test

what are 4 disadvantages to the Coombs test

1. doesn't tell what's causing the hemolysis 2. doesn't differentiate primary v secondary IMHA 3. False positives 4. False negative (doesn't rule IMHA out)

positive coombs test determines what

there is an immune mediated component of hemolysis

if you get a negative coombs test can IMHA be excluded from ddx list

NO! | many things that can result in a negative test, p may still have IMHA

how is infectious dz that may be causing secondary IMHA ddx

ID of parasite in blood or ancillary testing (PCR, serology, microbiology)

occurrence of oxidative damage depends on what 2 things

1. quantity and duration of exposure | 2. p ability to metabolize oxidant

oxidative damage results in decreased RBC __ and/or __ of damaged cells leading to hemolysis

deformability, premature removal

5 common oxidants (cause hemolysis)

1. acetaminophen (tylenol and panadol tablets) 2. allium genus (onions, garlic) 3. red maple leaves (horses, alpacas) 4. brassica genus (kale, rapeseed - ruminants) 5. propylene glycol in semi-moist foods (cats)

What oxidant is most likely to effect ruminants

brassica genus (kale)

what oxidant is most likely to effect horses and alpacas

red maple leaf

what animal is more sensitive to oxidative damage bc it has more sulfahydryl groups on it's RBC (targets for oxidation)

cats

is skunk musk and oxidant in dogs

yes

__ portion of hgb forms heinz bodies (oxidized ppt of hgb), cats can normally have a few of these.

globin

membrane of erythrocytes form __ due to lipid membrane oxidation

eccentrocytes

iron portion of hgb becomes ___, causes chocolate syrup blood, does not cause hemolysis but decreases O2 delivery to tissue

methemoglobin

3 targets for oxidative damage

1. globin of Hgb (heinz bodies) 2. iron of Hgb (methemoglobin, decreased O2) 3. lipid membrane (eccentrocytes)

seeing __ and __ on blood film is characteristic of oxidative damage

eccentrocyte shape and heinz body inclusions of RBCs

6 signs of hemolytic anemia caused by oxidant includes

1. regenerative anemia 2. history of exposure and clinical signs 3. lots of heinz bodies (NMB stain) 4. eccentrocyte and pyknocytes 5. methemoglobinemia (spot or filter paper test) 6. hgb crystals

__ is seen in puppies that have ingested pennies post 1982 which causes hemolysis

acute zinc toxicity

__ cells are seen in envenomation cases due to venom phospholipases causing hemolysis

spheroechinocytes (no central palar with spicules)

__ is a large animal issue after calving due to metabolic state/low ATP causing RBC to be fragile, normally rare

hypophosphatemia (can also be seen in small animals with diabetic ketoacidosis or lipidosis)

___ hemolysis is seen with rapid infusion of hypotonic fluid ("drown") or with calf milk replacer that has too much water

hypo-osmolar

__ and __ are common cell changes seen with regenerative anemia

anicocytosis and polychromasia

spherocytes are seen with __ hemolysis

extravascular

microscopic autoagluttination, spherocytes, ghost cells, anicocytosis, polychromasia, macrocytosis, nRBC =

IMHA

Bilirubenemia is ddx for intra or extravascular hemolyssi

neither! it occurs in both. only hemoglobinemia/uria is ddx

High WBC count but IMHA, can you give immunosuppressants?

yes, wbc count is due to immune response to hemolysis not infection

decreased PCV with increased TS helps exclude __ from being cause of regenerative anemia

hemorrhaging