Hematology and Anemia (MR) Flashcards Preview

Clinical Medicine Master > Hematology and Anemia (MR) > Flashcards

Flashcards in Hematology and Anemia (MR) Deck (74):
1

Is anemia a disease?

NO, just a Cx

2

What is the proper progression of diagnostic testing?

PVC, CBC w/ Retic Count
+/- BM Aspiration or biopsy (bx)
+/- Advanced ClinPath Testing

3

Who can handle Anemia really well?

Cats!

4

Anemia grading for Dogs?

Mild (30 – 36%) Moderate (18 - 29%)
Severe (<18%)

5

Anemia grading for Cats?

Mild (20 – 24%) Moderate (15 - 19%)
Severe (<14%)

6

What about MCV and MCHC helps us to determine Regenerative vs Non-Regenerative?

Patterns within species that are associated with different conditions

7

What are rule outs for Regenerative Anemia?

Hemorrhage, Hemolysis

8

If Anemia is Regenerative what will MCV & MCHC tell me?

Macrocytic Hypochromic

9

What can it mean if you have Normocytic & Normochromic (Homogenous)?

Not Anemia or Anemia

10

If Normocytic & Normochromic but Anemic what are the possible causes?

1. Non-regenerative 2º to Chronic Systemic Dz 2. 1º Bone Marrow Dz with failure of Erythropoisis

11

What are causes of Non-regenerative Anemia 2º to Chronic Systemic Dz?

Chronic Kidney Dz,Chronic Inflammatory Dz/Anemia of Chronic Dz - cytokines flying around inhibiting BM

12

Heterogenous look but still Normocytic Normochromic, what should you think?

Could be recent and regeneration has not really begun. Early Hemorrhage
Early Hemolysis
Chronic Hemorrhage
Early Fe Deficiency

13

Macrocytic & Normochromic is Regenerative or Non-regenerative? Caused by?

Regenerative - just not there yet. Caused by:Post-anemic period - Cats
Hyperthyroidism - Cats
Defective erythropoiesis - delayed nuclear maturation BM Dz

14

What are possible causes of Microcytic, Hypochromic?

Fe Deficiency Cu Deficiency
PSS – Puppies

15

What are possible causes of Microcytic, Normochromic?

PSS - Adult Dogs & Cats Healthy Akita Healthy Shiba Inu

16

When bloodwork doesnt make sense who should you be?

Skeptical Dog

17

If you dont have central palor in your red cells then what are they?

Spirocytes

18

If Anemia is regenerative and/or platelets are large is there any reason to biopsy BM?

NO, it is working. Hence, regeneration/large

19

What if you have a Normocytic, Norchromic, Non-regenerative Anemia with a Normal CBC, UA, no signs of Infection what should you do?

BM Aspirates/Biopsy

20

What is needed for BM core Biopsy?

General Anesthesia

21

How can you analyze BM?

Aspirates – Cytology. Biopsy (bx) – Histopathology

22

What can be evaluated by performing a BM Aspirate or Biopsy?

Precursors, Normal Development,
Maturation Process of all cell lines,
Abnormal Processes

23

Advanced Tests: What does Coombs test Dx? How?

Hemolysis & Agglutination from IMHA. Antiserum against Ab bound to RBCs

24

If agglutinating in tube, should you confirm dx with a Coombs test?

No, theyre agglutinating and that is the end result of the Coombs test.

25

Flow Cytometry detects what?

RBC Membrane bound Abs. MOST SENSITIVE!

26

Osmotic Fragility test detects what? Why is this test annoying?

RBC ↓ surface:volume ratio. RBC ↓ ability to Swell. Takes a long time and is very complicated

27

How regenerative is Anemia caused by Fe Deficiency?

Poorly

28

How regenerative is Anemia caused by Inflammation?

Not

29

How regenerative is Anemia caused by ↓ EPO/Kidney Dz?

Not

30

How regenerative is Anemia caused by Bone Marrow Damage?

Not

31

How regenerative is anemia caused by Maturation defects in Bone Marrow (myelophthisis) - reduction of cell forming function of the Bone Marrow?

Not

32

Which Hemolytic Anemias are caused by a ↓ in energy production? Which breeds are most likely to have this? (2)

HypophosphatemiaP. K Deficiency - Springer & Cocker Spaniels

33

Which Hemolytic Anemias are caused by Infectious Dz? Is this 1º or 2º IMHA?

Hemoplasmas Babesiosis 2º

34

Which Hemolytic Anemias are caused by Oxidative Damage?

Acetominophen Onions

35

Which Hemolytic Anemias are caused by Fragmentation?

DIC

36

Which Hemolytic Anemias are caused by Immune Mediated RBC Lysis? Which one is worse?

IgG TENDS to be - Extravascular Hemolysis/Phagocytosis. C3b tends to be - Intravascular Lysis. C3b - Complement is always worse - how body kills shit fast

37

Why do we get shistocytes with 2º infectious IMHA?

Spleen macrophages try not to kill whole cell and just chomp out a bite! Silly spleen!

38

Fe Deficiency Anemia in Neonates is due to? (3)

Low stores, Milk is low in Fe,
They are expanding their blood volume very quickly

39

Fe Deficiency Anemia in Adults are due to? Where is this probably happening?When does it become evident?

Chronic Blood Loss out of the body, GI bleed, evident after Moderate to Severe depletion of Fe Stores

40

In Fe Deficiency anemia what will RBCs look like? How regenerative is this?

Microcytic Hypochromic Target cells - Ton of Central Pallor
Poikilocytes
Poorly Regenerative

41

What are the 2 most common and accessible Iron Assessment tests?

Serum iron on Chemistry, Stainable Fe in BM samples

42

What causes non-regenerative Anemias? (2)

Acute Hemmorhage - no response of generation yet. ↓ Erythropoiesis 2º to Medullary Dz
Chronic Inflammatory Dz
Kidney Dz
BM Dz

43

What causes ↓ EPO?

CKD, Inflammation

44

What effect does inflammation have on erythropoiesis/RBCs? How?

↓ RBS Life Span ↓ EPO production
↓ Marrow Response to EPO
Fe Sequestration
: Cytokines, TNF, IL-2, IL-6, IFN

45

What causes defective or ↓ Erythropoiesis?

↓ : Hemoglobin Synthesis, Nucleic Acid Synthesis,
Defective Maturation:

46

What disease do neutrophils not mature past bands?

Pelger-Hewitt Abnormality

47

Is IMHA regenerative or non-regenerative?

Highly Regenerative

48

Which Immune Mediated failures of erythropoiesis are non-regenerative? (3)

IMIE - IM Ineffective Erythropoiesis (attacking precursor cells), Pure Red Cell Aplasia,
Aplastic Anemia (aplastic pancytopenia) - kills all the baby cell precursors

49

Which type of Immune Mediated Anemia would affect these cells?

PIC Aplastic Anemia

50

Which type of Immune Mediated Anemia would affect these cells?

PIC Pure Red Cell Aplasia

51

Which type of Immune Mediated Anemia would affect these cells?

PIC IMIE

52

Which type of Immune Mediated Anemia would affect these cells?

PIC IMHA

53

How many days do Neutrophils live? Platelets? Red Blood Cells?

N: 1,P: 1, RBC: 100

54

How quickly does anemia develop with failure of erythropoiesis?

Slowly

55

How do Cx present for anemia with failure of erythropoiesis?

Abruptly and Severely

56

What will RBCs look like for MCV & NCHC?

Normo Normo

57

Reticulocyte count?

Low Retic count

58

What dzs are the result of FAILURE of erythropoiesis?

Aplastic Anemia, PRCA - Pure Red Cell Aplasia,
IMIE - IM Ineffectice Erythropoiesis

59

Erythrocytosis: which type is most common? What causes this type? What other parameter will you most likely see with this type? What creature can have this and it is fairly normal for them?

Relative type is most common. Caused by: Dehydration/hemoconcentration
Other parameters: Total Proteins. Normal for: Sight Hounds

60

What is Absolute Erythrocytosis? What is your PCV?

True ↑ in RBC mass. 70% - 80%

61

What is 1º Erythrocytosis caused by? What type of Dz is this? What causes the erythrocytosis?

Caused by: Polycythemia rubra vera - tumor of red cell precursors. Type of Dz: Myeloproliferative - bone marrow pumpin out too many precursors. Erythrocytosis caused by: ↑ production of RBC precursors
VERY UNCOMMON SO RARE!

62

What is 2º Erythrocytosis caused by?

↑ EPO

63

What causes ↑ EPO?

Chronic tissue hypoxia (most common), Inappropriate EPO production

64

What causes Chronic Tissue Hypoxia which can lead to ↑ EPO?

R-L Shunt Chronic Pulmonary Dz - Brachycephalic Dz
High altitude
Variant Hb

65

What can cause Inappropriate EPO production which can lead to ↑ EPO?

Renal Issues: Tumors, cysts, pyelonephritis (local ischemia), Aberrant EPO production - neoplasia anywhere,
Endocrinopathies - hyperadrenocorticism, hyperthyroidism

66

What are the consequences of Erythrocytosis?

↑ Blood Volume &/or Viscosity

67

What are possible consequences of ↑ blood volume?

↑ CO, Chronically: CHF

68

What are possible consequences of ↑ blood viscosity?

Poor tissue perfusion - too many red cells backing up in capillaries, Hemorrhage
Thrombosis
Cyanosis

69

What is the study of blood flow?

Rheology

70

What are the CX of Erythrocytosis?

Generally related to the underlying cause considering most erythrocytosis are 2º. Hyperemia
Splenomegaly
Neurological - seizures & ataxia
PU/PD
Microcytosis - Fe Deficiency

71

What is the dz of blue-eyed dilutes where they have large granules?

Chédiak-Higashi Syndrome - BM abnormality in WBC precursors

72

Tx of Erythrocytosis?

Tx Underlying Dz: Phlebotomy - fluid replacement
Hydroxyurea - drug
Maintain high normal PCV

73

Why would it be beneficial to maintian a high PCV with erythrocytosis?

Dont want to stimulate EPO

74

What is long term survival like with 1º erythrocytosis?

Good :)