Lecture 18: Anemia Flashcards
1
Q
What are some signs of anemia
A
- Tachypnea
- Tachycardia
- Pale, icteric, tacky MM
2
Q
what is a likely ddx for small young puppy with anemia, large distended abdomen
A
hookworms
3
Q
what cause of anemia is icterus typically associated with
A
hemolysis
4
Q
What ectoparasites can cause severe anemia in dogs and cats
A
dogs- babesia canis
Cats- mycoplasma hemofelis
5
Q
what drugs can cause bone marrow suppression/problems
A
chemotherapy, methimazole, phenobarbital, chloramphenicol
6
Q
if you have a low TP and rengerative anemia what type of anemia is most likely occurring
A
blood loss
7
Q
what is HCT for dogs and cats with regenerative anemia
A
dogs: <35%
Cats: <30%
8
Q
what is total protein in dogs and cats with regenerative anemia
A
Dogs: 5.5-7.4
Cats: 6.0-8.0
9
Q
what is absolute reticulocyte count in dogs and counts with regenerative anemia
A
dogs: >100k
Cats: >60k
10
Q
what is corrected retic % in dogs and cats with regenerative anemia
A
dogs: >1%
Cats: >0.4%
11
Q
reticulocytes are prematurely released from bone marrow in response to elevated __ levels induced by __
A
erythropoeitin induced by tissue hypoxia
12
Q
what are the 2 causes of regenerative anemia
A
- Loss
- Destruction/hemolysis
13
Q
what is the cause of non-regenerative anemia
A
- Decreased production
14
Q
how long does it take for reticulocytosis to occur and indicate a regenerative anemia
A
3-5 days
15
Q
how would a patients reticulocyte count appear with acute blood loss (ex: HBC)
A
would appear non-regenerative- not enough time for BM to respond, but will eventually become regenerative
16
Q
t or f: chronic blood loss is a regenerative anemia
A
false- non-regenerative
17
Q
what is HCT for non-regenerative anemia in dogs and cats
A
dogs: <35%
Cats<30%
18
Q
what is absolute retic count and corrected retic % for non-regenerative anemia in dogs and cats
A
dogs: <100K, <1%
Cats: <60K, <0.4%
19
Q
what are the 4 causes of non-regenerative anemia
A
- Bone marrow disease
- Acute/chronic inflammation
- Chronic blood loss
- Not enough erythropoeitn (kidney dz/injury)
20
Q
What are some examples of things that can lead to bone marrow disease and therefore decreased production/ non-rengerative anemia
A
- Myelophthisis
- Myelofibrosis
- aplastic pancytopenia
- Toxins/drugs
- PIMA
- Pure red cell aplasia
- Myelodysplastic syndrome
21
Q
Classify anemia for decreased erythropoeitin production
A
normocytic, normochromic, non-regenerative
22
Q
is anemia from decreased erythropoetin mild, moderate or severe
A
moderate to severe
23
Q
when do you tx anemia
A
- Symptomatic (lethargy, weakness, tachycardia, tachypnea, etc)
- Hematocrit cutoff
- dogs <20%
-cats: <15-17%
24
Q
how do you tx an anemia crisis
A
- Blood transfusion
- Erythropoetin stimulating agent (darbepoetin, epogen)
25
how do you tx stable anemia
1. Erythropoetin stimulating agent (darbepoetin>>epogen)
2. Iron dextran
26
is anemia of inflammatory disease mild, moderate or severe
mild
27
what is HCT for anemia of inflammatory disease in dogs and cats
Dogs: 25-30%
Cats: 20-24%
28
what is MCV and MCHC for anemia of inflammatory disease
Normocytic, normochromic
29
anemia of inflammatory disease results in __defcieincy because its sequestered
iron
30
t or f: anemia of inflammatory disease will always cause inflammatory leukogram
false- not necessarily
31
are anemias due to bone marrow disease mild, moderate or severe
moderate to severe
32
what is HCT for bone marrow disease in dogs and cats
dogs: <25%
Cats: <20%
33
t or f: clinical signs from bone marrow disease are chronic and gradual
true
34
what are some BW signs of bone marrow disease
neutropenia, thrombocytopenia, bi or pancytopenia
35
What is gold standard to dx bone marrow disease
1. Bone marrow cytology
2. Bone marrow core biopsy
36
what is the most common cause of bone marrow mediated non-regenerative anemia in dogs
precursor targeted immune mediated anemia (PIMA)
37
is anemia mild, moderate or severe with PIMA
moderate to severe
38
what dog breeds are overrepresented with PIMA
dachshunds, labs, whippets
39
What blood work sign can be seen in dogs with PIMA
hyperbilirubinemia
40
what are some signs of cytology/biopsy of BM that are indicative of PIMA
1. Erythrophagocytosis
2. Erythroid hyperplasia
3. Erythroid hypoplasia
4. Maturation arrest
41
What is prognosis for PIMA
50-75% will achieve remission (normal HCT)
42
what is median time to respond to PIMA tx and median time to remission
response: 1 month
Remission: 2 months
43
what is a major complication of PIMA
thromboembolic complications
44
What is tx for PIMA
1. Prednisone
2. +/- cyclosporine or mycophenolate
3. +/- blood transfusions
4. Antithrombotics- clopidogrel
45
t or f: do not taper immunosuppressive drugs when tx PIMA until dog is in remission
true
46
how long does remission from PIMA usually take
4-6 months
47
after remission from PIMA decrease prednisone dosage by no more than __% at each visit
25%
48
with PIMA tx recheck CBC with retic count every __-__ weeks
3-4 weeks
49
What “red flag” sign are you looking for when tx PIMA with immunosuppressives
if dog becomes anemia and has insufficient reticulocytes- revert back to previous dose that work
50
is anemia due to pure red cell aplasia (PCRA) mild, moderate or severe
moderate to severe
51
what are cytology/biopsy sings supportive of pure red cell aplasia
1. Erythroid hypoplasia
2. Rare to see erythrophagocytosis
3. No maturation arrest
4. No erythroid hyperplasia
52
what is tx for pure red cell aplasia
1. Prednisone
2. +/- cyclosporine or mycophenolate
3. +/- blood transfusions
4. Antithrombotics
53
what is typical age of cats with PIMA or PRA
< 3years
54
what is HCT/anemia for PIMA and PRA in cats
moderate to severe anemia
HCT 6-19%
55
what is tx for cats with PIMA and PRA
1. Transfusion
2. Prednisolone
3. +/- chlorambucil or cyclosporine
56
what is median time to remission in cats with PIMA or PRA
1 month
57
what drugs can cause aplastic pancytopenia
1. Chemotherapy
2. TMS
3. Albendazole/ fenbendazole
4. Azathioprine
58
what infections can cause aplastic pancytopenia
1. Ehrlichia canis
2. Parvo
3. FeLV
4. Histoplasmosis
59
what neoplasms can cause aplastic pancytopenia
1. CLL
2. ALL
3. AML
4. Multiple myeloma
60
__toxicity from sertoli cell tumors or creams can cause aplastic pancytopenia
estrogen
61
what is most common cause of aplastic pancytopenia
1. Idiopathic
62
what is prognosis for aplastic pancytopenia
poor
63
what is tx for aplastic pancytopenia
1. Immunosuppressive agents
2. Darbepoetin
3. GM-CSF
4. Vitamin B12
5. Broad spectrum abx- clavamox, bacterial
64
define myelophthisis
displacement of hematopoietic bone marrow tissue by infection or neoplasia
65
what is a very common cause of cytopenias in cats, especially anemias
FeLV
66
is anemia caused by FeLV regenerative or non-regenerative
non-regenerative
67
what is MCV and MCHC in FeLV
macrocytic hypochromic
68
any cat with moderate to severe anemia needs to have __ test performed even if owner says cat is indoors only
FeLV
69
what is prognosis for FeLV
poor
70
Acute blood loss is __whereas chronic blood loss is __ (Regen or not)
regenerative, non-regenerative
71
what bloodwork signs indicate blood loss as cause of anemia
low TP
72
what is MCV MCHC for chronic blood loss leading to non-regenerative anemia
microcytic, hypochromic
73
microcytic, hypochromic is indicative of __
iron deficiency
74
what are the mechanisms for blood loss
1. GI disease (ulcers, enteropathy, neoplasia)
2. Urinary
3. Bleeding into body cavities
4. GI parasites or ectoparasites (young animals)
5. Coagulopathies
75
what is tx for blood loss
1. Tx underlying disease
2. Blood transfusion if HCT< 20% dogs, <15-17% cats and symptomatic
76
if you have chronic blood loss causing non-regenerative anemia and microcytic hypochromic what do you need to tx with
iron dextran (iron deficiency anemia)
77
What are the clinpath signs for hemolysis
1. Hyperbilirubinemia
2. Bilirubinuria
3. Hemoglobinuria/ hemoglobinemia
4. Ghost cells
78
what is MCV and MCHC for hemolysis
macrocytic hypochromic
79
t or f: patients with hemolysis are usually acutely systemically ill
true
80
spherocytosis is usually indication of __destruciton
immune mediated
81
what are 2 types of hemolysis
intravascular and extravascular
82
t or f: not all hemolysis is IMHA that requires immunosuppression
true
83
what are some causes of hemolysis that do not require immunosuppression
1. Heinz body anemia (toxins)
2. Hypophosphatemia
3. Hemotropic infections
4. Hereditary osmotic fragility
5. Hereditary PK or PFK deficiency
6. Fragmentation hemolysis
7. Hemophagocytic syndrome
8. Heavy metal toxicity
9. Envenomation
84
t or f: you need to blood type dogs before first transfusions
false
85
t or f: all cats must be blood typed for first transfusions but not cross-matched
true
86
type B cats that receive type A blood with have __ reaction. Type A cats with receive type B blood have __reaction
severe, mild
87
how does feline neonatal isoerythrolysis occur
breeding type B queen to type A tom
88
how is babesia spp transmitted
1. Ticks (B. Canis)
2. Transplacental
3. Fighting
4. Blood transfusion
89
what are some signs of babesia infections
1. Fever
2. Hepato-splenomegaly
3. Icterus
90
what breed is B. Canis vs B. Gibsoni common in
B. Canis: greyhounds
B. Gibsoni: pit bulls
91
what lab findings are consistent with Babesia infections
1. Anemia thrombocytopenia
2. Hyperglobulinemia
3. +/- hyperbilirubinemia
4. +/- bilirubinuria
5. +/- 4DX snap +
6. +/- autoagglutination, spehrocytes, Coombs +
92
how do you dx babesia infections
1. Cytology
2. Babesia spp PCR
4. Antibody ELISA
93
antibody ELISA for babesia >__ indicative of infection or increasing titer from baseline to 2 weeks
>1:64
94
identify organisms
left: B. Canis
Right: B. Gibsoni
95
what is tx for B. Canis infection
1. Supportive care- blood transfusions, anti-thrombotics, IVF
2. Imidocarb diproprionate
96
what is tx for B. Gibsoni
1. Supportive care- blood transfusions, anti-thrombotics, IVF
2. Azithromycin
3. Atovaquone
97
what are some red flags to test for babesia spp in dogs with hemolysis
1. Puppy or young dogs
2. High exposure to ticks
3. No monthly preventatives
4. Pit bull or greyhound
5. Hx dog fights or transfusions
98
Mycoplasma hemofelis is bacteria on surface of__
RBC
99
what are risks factors for mycoplasma hemofelis
1. Young age
2. Male
3. Outdoor access
4. FIV or FeLV +
100
how is mycoplasma hemofelis transmitted
arthropods (fleas), blood transmission from cat bite, blood transfusion
101
what are some signs of mycoplasma hemofelis
1. Fever
2. Splenomegaly
3. Icterus
4. Hypoxia
102
what are some lab signs of mycoplasma hemofelis
1. Regenerative anemia
2. +/- autoagglutination
3. Mild-mod hyperbilirubinemia
4. +/- increased ALT or AST
103
how do you dx mycoplasma hemofelis
1. Cytology (poor sensitivity and specificity)
2. PCR- test of choice
104
what is tx for mycoplasma hemofelis
1. Supportive care- blood transfusions, IVF
2. Doxycycline or pradofloxacin
3. +/- prednisolone
105
What is cause of immune mediated hemolysis
antibodies attack RBCs
106
what are some blood smear signs of immune mediated hemolysis
1. Microagglutination
2. Macroagglutination
3. Spherocytes
4. Ghost cells
107
how do you perform saline agglutination test
1 drop of blood, 4 drops of saline
Blood must come from EDTA anticoagulated tube
108
what are some BW signs indicative of IMHA
1. Spherocytes (dogs)
2. Agglutination +
3. Coombs +
4. Hyperbilirubinemia
5. Bilirubinuria
6. Hemoglbonemia/uria
7. RBC ghost cells
109
what is average age for primary idiopathic IMHA
6 years
110
what are some signs of primary, idiopathic IMHA
Acute ~ 3 days of lehtargy, anorexia, vomiting, fever, moderate to severe anemia, leukocytosis, thrombocytopenia
111
<3% of dogs with IMHA are less than __years old
1
112
what is median age of feline IMHA
2 years
113
hemolytic anemia in cats, must test for __ and __
FeLV and mycoplasma hemofelis
114
what is prognosis for IMHA
50% mortality but remove finances mortality rate drops 3-%
115
what are some negative prognostic indicators for IHMA
1. Intravascular hemolysis
2. Total bilirbun >5mg/dl
3. Increased BUN
116
what is most common complication of IMHA
thromboembolism
117
what is tx for IMHA
1. PRBC transfusion
2. Glucocorticoids +/- additional immunomodulator
3. Anti-coagulant (rivaroxaban, heparin), anti-platelet (clopidogrel)
118
patients with IMHA must have >__ platelets to use anti-thrombotic
30k
119
when can patients with IMHA go home from hospital
1. Eating and drinking well
2. No more than 3-5% decrease in HCT/PV in 24hrs and HCT/PCV >17%
120
wat are long term goals of IMHA tx
1. Gradually get patient of all immunosuppressives within 8 months
2. HCT/PCV remained stable and >30% for at least 2-3 weeks
121
If tx IMHA with just prednisone decrease dose by no more than __%, if tx with 2 immunosuppressives decrease prednisone by __% and do not change __
25%, 50%, do not change second drug
122
how long should patients with IMHA stay on anti-platelet and/or anti-coagulants
first 2-3 months
