Clinical Approach to Anaemia SA Flashcards by laura knight

CLinical signs seen with anaemia?

none/vague if mild or chronic
non-specific lethargy, anorexia, collapse
specific = pale mms, ^ HR, ^RR, murmur, hyperdynamic pulses
severity of signs reflects cause, chronicity and severity of anaemia

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What are ddx for pale mms?

> poor perfusion
- probably prolonged CRT
- weak pulses
> anaemia (euvolaemic) 
- normal CRT
- strong pulses (^CO so greater difference betweend iastolic and systolic)

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What does ^ HR and RR indicate in an anaemic patient?

attempting to compoensate

= severe anaemia

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How does chronic and acute anaemia present differnetly?

chronic animal can adapt so cat with chronic anaemia 8% PCV can appear more stable than
dog with aute onset PCV 18%

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Is signalment ver relevant to anaemia?

YES
> young
- lower PCV normal, pale mm 
- parasites
> older
- neoplastic 
- renal 
> breeds
- cocker IMHA

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Important hx points with anaemia?

lifestyle
stable or deteriorating
site of bleeding (melana and haematuria, epistaxis)
access to drugs or toxins
travel hx

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PE points important for anaemia?

stable
HR, RR, demarnour
icturys
pleural and peritoneal space (auscultation and fluid thrill)
concurrent disease
masses/pain
rectal (meleana)

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Diagnostic approach to pale mms?

> poor perfusion v anaemia
- PCV/TP
- TP v haemorrhage, ^~ haemolysis or non-regenerative anaemia
regenerative v non-regenerative
- time scale
- measure reticulocyte count (correct for PCV or use absolute count better)
* >60,000/ul dog or >40,000/ul cats = regenerative
- blood smear evaluation in house (polychromasia, nRBC)
evidence of underlying cause on smear?
- immune-mediated destruction
- mechanical destruction
- infectious agent

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Reasons for regenerative anaemia?

> haemorrhage

internal (spleen dogs, thorax, trauma, amyloidosis hepatic in cats)
external (epistaxis, parasites, meleana, UT)

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Why may the spleen be enlarged in anaemia?

Help to regenerate RBCs

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What might you want to check with haemorhaging patients?

> TP always
\+- 
-coagulation 
- platelet count always
- feacal lungworm (angiostrongylus vasorum)
- ACTH (Addisons s-> GIT Ulceration) 
- search body cavities

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Tx blood loss anaemia?

> Tx/remove underlying cause

remove spleen/gut
gastro-protectant if ulcerated but not surgical
remove cause of ulceration
tx lungworm
blood transfusion?

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Types of haemolysis

> intravascular 
- complement and IgM mediated
- haemalgobinaemia and haemoglobinuria
> extravascular
-  mcrophages in spleen liver etc. IgG mediated

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what signs may help you to differentiate the type of haemolysis

autoagglutination?
Coombs test?
Haemaglobinuria
Bilirubinuria

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4 main cauases of haemolytic anaemia

> IMHA 
- 1* idiopathic
- 2* 
> inherited haemolytic anaemia 
- PK deficinecy
- PFK deficiency 
> Infectious causes
> Misc

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Signalment and findings for IMAH

> spaniels
- regenerative anaemia
- no sign of blood loss
- suggestion of haemolysis (jaundice, auto-agglutination (in-saline) spherocyte, ghost cells
- R/O underlying dz 
> babesia, ehrlichia, non-blood cells

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Tx IMHA?

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IV fluid tx/blood tranfusion/hboc - oxyglobin not available)
immunosupressive tx
? aspirin, clopidogrel
? gastroprotectant
nursing (IV catheter, gentle walks)

Main immunosuppressives to tx IMHA?

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> Prednisolone
- suppresses macorphages, complement and Ab binding, suppresses IgG
+ Azathioprine (NOT CATS)
- cyclosporine, mycophenolate, chlorambucil (CATS)

Prognosis IMHA?

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> guarded
- intravascualr worse
- icterus, haemaglobinaemia/uria, poor regeneration, all poor prognostic indicators
common cause of death PTE (thromboembolism)
may relapse
monitor
- regular PCV/TP and haem prior to each dose reduction
- regular biochem drug toxicity

What type of IMHA is most common in cats?

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1* (despite old literature)

Why is IMHA in cats more difficult?

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Dx hard

- giving blood products mroe challenging ni cats (often give more volume watch for overload)

How does Babesia differ from IMHA?

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looks very similar
more sick with babesia
more intravasc ?

Specieis of babesia. How is this spread controlled?

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B. Canis in europe
B. Gibsoni other areas
> travel scheme

Which species does mycoplasma affect?

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cats mainly

- dogs too after splenectomy

Which infections can act as an immunological trigger for IMHA?

- Any theoretically -> 2* IMHA

Miscellaneous causes of haemolysis

``` > oxidative damage - paracetamol (cats) - onions, garlic, Zn, Cu > hypophosphataemia (DKA) > shear injury (microangiopathic) d/t damaged endothelium ```

How do non-regenerative anaemia patients present?

- mild/severe - may be o nvious on PE or not - variable!! > reticulocytes -

Most common cause fo non-regenerative anaemia?

- anaemia of chronic inflammation Mild - moderate anaemia (dogs 25-36%, cats 18-26%) - chronic infections and non-infectious disorders - d/t poor iron storage/utilisation and shortened red cell survival, imparied erythrocyte production

What type of anaemia does renal dz cause?

- normocytic, normochromic | > not always obviuos on PE

Pathogenesis of renal dz anaemia?

- inadequate EPO production - decreased erythrocyte lifespan - decreased marrow response to EPO - other factors (haemorrhage caused by uraemic ulcers etc.)

What should always be tested for in anaemic cats?

- FeLV

What type of anaemia does FeLV cause?

- macrocytic normochromic or normocytic normochromix in chronic dz - may induce IMHA/1* BM dz - >75% anaemic cats found to be FeLV+ in past studies

3 main miscellaneous non-regenerative anaemia

``` > nutrient - iron deficieny - copper def (Cu associated hepatitis in labs) - folate/cobalamin deficiency (neutropenia, severe non-regen anaemia,s tunted growth, inherited dz in some breeds) > endocrine - hypothyroid - hypoadrenocorticism - hyperestrogen - mild-mod anaemia, severe pancytopenia poss with hyperestrogenism > liver - young dogs with PSS - mild-mod - iron metabolism affected ```

Types of BM dz? What type of anaemia would this cause?

> non-regenerative - pure reed cell aplasia - aplastic anaemia (pancytopenic) - neoplaisa (myelophthisis) - myelodysplasia (abnormal development RBC) - myelofibrosis (fibrosis replaces BM)

Approach to non-regenerative anamiea

- depends on severity - similar investigation path to regenerative anaeia but Ddx different (look for dz) - if severe and no cause found on screening tests - BM - Bi-pancytopenia - BM

Where are BM samples taken?

- humerus or iliac crest

Outline BM sampling technique

- sedation + local/GA - clip and prepare aseptically - aspirate (once obtained smear quickly as clots in seconds) - core-roll preparations then into formalin

Tx BM dz -> non-regenerative anaemia?

- pure red cell aplasia (= IMHA Tx) - aplastic anaemia (?) - neoplasia (myelpthisis) - myelodysplasia (NO tx) - myelofibrosis (revesible, tx underlying dz)

What is anaemia?

- NOT a clinical sign/dx = v PCV, HCT, Hb, RBC may or may not be obvious on PE

Clinical Approach to Anaemia SA Flashcards

(40 cards)