Lecture 2: RBC II: regenerative anemia Flashcards
1
Q
What are some signs of anemia
A
Pale MM, increased CRT, lethargy, tachycardia, tachypnea, low grade arrhythmias
2
Q
what are some differentials for anemia
A
- Loss
- Destruction
- Decreased production
3
Q
what type of anemia is associated with loss
A
initially regenerative to non-regenerative
4
Q
what type of anemia is associated with destruction of RBC’s
A
regenerative
5
Q
what type of anemias associated with decreased RBC production
A
non-regenerative
6
Q
what are some causes of destruction causing anemia
A
IMHA, oxidative damage, infections, environmental// biochemical, intrinsic RBC defects
7
Q
are reticulocytes indicative or regenerative or non-regenerative anemia
A
regenerative
8
Q
is reticulocyte higher or lower with regenerative anemia
A
higher- reticulocytosis
9
Q
what are the mechanisms for regenerative anemia
A
- Blood loss
- Hemolysis/destruction
10
Q
what are the analyzer findings: MCV, MCHC, and reticulocytes for regenerative anemia
A
- MCV: high (macrocytosis)
- MCHC: (Hypochromasia) decreased (bone marrow releasing younger cells, less Hgb)
- Reticulocytosis (not horses)
11
Q
what are the blood smear findings with regenerative anemia
A
- Moderate to marked ansiocytosis
- Moderate to marked polychromasia
- Moderate to marked basophilic stippling (ruminants)
12
Q
what are the blood smear findings of regenerative anemia in dogs and cats
A
- Anisocytosis
- Release of polychromatophils
- Metarubricytosis and HJ bodies
13
Q
what are the regenerative anemia signs on blood smear for horses
A
- May see anisocytosis
- Do not release polychromatophils!
14
Q
What are some signs of regenerative anemia on blood smear for cattle
A
- Ansiocytosis
- Release of polychromatophils
- Basophilic stippling
15
Q
blood smear from dog or cat, what do you see and what indicative of
A
Polychromatophils, ansiocytosis
Regenerative anemia
16
Q
blood smear from cattle, what do you see and what does it indicate
A
Basophilic stippling, polychromatophils, anisocytosis
Regenerative anemia
17
Q
how does bone marrow respond/ what results seen on analyzer and blood film with regenerative anemia
A
- Reticulocytosis on CBC
- Elevated MCV
- Decreased MCHC
- Increased polychromatophils
- Basophilic stippling in ruminants
18
Q
t or false metarubicytes/ nRBC’s are seen in healthy animals
A
false
19
Q
t or f: increased nRBC’s/ metarubriocytes = regeneration
A
false
20
Q
on analyzer nRBC’s are counted as __ therefore is common cause of false __
A
WBC’s, lymphocytosis
21
Q
which of the following are nRBC’s vs lymphocytes
A
left: nRBC’s
Right: lymphocytes
22
Q
what is the N:C ratio for nRBC’s vs lymphocytes
A
both high, but more cytoplasm in nRBC’s
23
Q
what color is cytoplasm a for nRBC’s vs lymphocytes
A
nRBC’s: red/purple
Lymphocytes: blue
24
Q
nRBC’s or lymphocytes: pyknotic nuclei
A
nRBC’s
25
NRBC’s or lymphocytes: heterogenous chromatin
lymphocytes
26
which has smooth vs irregular cell borders: nRBC’s and lymphocytes
nRBC’s: irregular cell borders
Lymphocytes: smooth cell borders
27
increased # nRBC’s in circulation= __
metarubricytosis
28
nRBC’s in circulation are characterized by __ vs___
appropriate vs inappropriate metarubricytosis
29
what is appropriate metarubricytosis
increased nRBC’s in circulation with evidence of regeneration—-> metarubricytosis + reticulocytosis
30
what is inappropriate metarubricytosis
1. Endothelial cell damage
2. Metarubricytosis with no other signs of regeneration
31
what are Howell jolly bodies
small pieces of non-function nucleus
32
t or f: Howell jolly bodies= regeneration
false, can see increased numbers with regeneration but does not = regeneration
33
what circled
Howell jolly bodies
34
Describe the steps from tissue hypoxia to reticulocytosis in rengerative anemia
1. Tissue hypoxia stimulates erythropoietin production
2. EPO stimulates RBC production in bone marrow
3. Reticulocytosis in circulation
35
Identify 1-2, what do they indicate
1. Polychromatophils
2. NRBC
Indicate regeneration
36
what value do you always need from CBC analyzer to determine if regenerative
absolute reticulocyte count
37
what blood work finding do you also see with regenerative anemia from blood loss that can help you differentiate from hemolysis
hypoproteinemia
38
what is per-acute hemorrhage and what are analyzer findings (MCV MCHC, reticulocyte count)
before BM has had time to respond, within/before 3-5 days
Analyzer: normocytic, normochromic, retics within RI
39
what is acute hemorrhage and what are analyzer findings (MCV, MCHC, reticulocyte count). What is iron level
At least 3-5 days after, still has adequate iron levels
Analyzer: macrocytic, hypochromic, elevated retics
40
what is chronic hemorrhage, what are iron levels, what are analyzer findings (MCV, MCHC, reticulocyte count)
over several days to weeks, iron deficient
Analyzer: microcytic, hypochromic, retics within RI
41
case ex: 1yr, FS mixed breed dog, hx of exercise intolerance, lethargy, pale MM, tachycardia. Following is patients CBC. Characterize the erythron, what likely cause
1. Low total protein
2. Low hematocrit (anemic)
3. MCV elevated: macrocytic
4. MCHC: low- hypochromic
5. Reticulocytes: high- regenerative
Erythron: macrocytic, hypochromic, regenerative anemia
Causes: blood loss, parasites
42
case ex: 3yr, M cocker spaniel, hx HBC 1 day ago, painful abdomen, excessive fluid in peritoneal cavity. Following is CBC. Characterize erythron and what is most likely cause
1. Total protein- low
2. Hematocrit: low- anemic
3. MCV: normocytic
4. MCHC: normochromic
5. Reticulocytes: normal
Erythron: normocytic, normochromic, non-regenerative anemia
Most likely cause: external blood loss, too early for regenerative response
43
for regenerative anemia what is MCV and MCHC: high or low
MCV: elevated- macrocytic
MCHC: low- hypochromic
44
Extravascular or intravascular hemolysis: hyperbilirubinemia, bilirubinuria
extravascular
45
extravascular or intravascular hemolysis: hemoglobinuria, hemoglobinemia
intravascular
46
what is total protein with intra and extravascular hemolysis
normal, can differentiate from blood loss anemia
47
what cells/ blood smear changes may you see with hemolytic anemia
spherocytes, eccentricities, Heinz bodies, ghost cells
48
where does extravascular hemolysis occur
outside vasculature, destruction occurs in macrophages near venous sinuses in spleen, liver and bone marrow
49
what pokilocyte is associated with extravascular hemolysis
spherocyte
50
what is pathogenesis of extravascular hemolytic anemia
1. Macrophages convert HBG
2.Unconjugated bilirubin
3. Liver can’t keep up
4. Bilirubinemia that spills over
5. Biliruibinuria
51
what poikilocytes are associated with intravascular hemolysis
Heinz bodies, eccentricities, ghost cells
52
what is hemoglobinemia and how does it affect plasma color
free Hgb in plasma/serum
Bright red discoloration of plasma
53
how does hemoglobinemia affect MCHC, MCH on CBC
artificially increased
54
what is the most common cause of hemolytic anemia in dogs
IMHA
55
Is IMHA extravascular or intravascular hemolysis
extravascular
56
what is most common cause of IMHA
idiopathic
57
what are the analyzer findings- MCV, MCHC with IMHA
1. MCV: Macrocytic
2. MCHC: hypochromic or falsely normal
58
what blood smear findings are consistent with IMHA
polychromasia (regenerative), spherocytes
59
what are arrows pointing at and what are these associated with
spherocytes
IMHA
60
how do you dx IMHA
1. CBC findings- macrocytic and hypochromasia
2. Blood smear- polychromatophils and spherocytes
3. Saline agglutination
4. Coomb’s test
61
what are some toxins that cause intravascular hemolytic anemia
acetaminophen, red maple leaf, onions and garlic, zinc, copper
62
Heinz bodies in cats are not considered significant unless >__% of RBC’s in cats
10%
63
what are some diseases that cause >10% of RBC’s to be Heinz bodies in cats
1. DM
2. Lymphoma
3. Hyperthyroidism
64
case ex: 2yr old M Pomeranian hx sudden onset vomiting, lethargy, brown urine. Owners found pile of pennies in vomit. Pale MM, tachycardia, tachypnea. The following CBC was done. Interpret erythron and what likely cause
1. Total protein- normal
2. Hematocrit- low (anemia)
3. MCV: macrocytic
4. MCHC: hyper chromatic (lies)
5. Reticulocyte count- normal
Erythron: macrocytic, hyperchomatic, non-regenerative anemia
Likely regenerative but too early
Intravascular hemolytic anemia due to zinc toxicity
65
how do pennies cause zinc toxicity
copper coating dissolved in acid in stomach and directly irritates erythrocytes
66
what are some infectious organism that cause hemolytic anemia
1. Mycoplasma
2. Babesia
3. Theileria
4. Anaplasma
67
what type of anemia does cytauxzoon cause
nonregenerative anemia
68
mycoplasma infect the __ of RBC
surface
69
what organism
mycoplasma
70
Cat- what organism
cytauxzoon delis (signet ring shape_
71
what spreads mycoplasma haemofelis
fleas
72
what type of anemia does mycoplasma haemofelis cause
regenerative hemolytic anemia
73
what is the most common infectious cause of hemolytic anemia in cats
mycoplasma haemofelis
74
mycoplasma haemofelis is etiologic agent for __
Feline infectious anemia
75
what spread cytauxzoon Felis
ticks
76
what type of anemia does cytauxzoon Felis cause
non-regenerative anemia
77
from greyhound what likely cause
Babesia canis (tear drops)
78
from pit bull what cause
Babesia Gibsoni (ring)
79
What are the two possible causes of equine piroplasmosis
1. Theileria equi
2. Babesia caballi
80
what organism
Anaplasma marginale
81
hemolytic anemia with RBC fragmentation is seen with what diseases
1. DIC
2. Heart failure
3. Vasculitis
4. Heart worms
5. Neoplasms
82
case ex: 6yr old Gelding with exercise intolerance, anorexia, lethargy, pale MM, tachycardia and tachypnea. Following CBC was performed. Characterize erythron. Patients plasma was bright red. what is a likely cause
1. Total protein- normal
2. Hematocrit- low (anemia)
3. MCV: macrocytic
4. MCHC: hyper chromatic (lies)
5. Do not release reticulocytes
Cause: intravascular hemolytic anemia- toxin/ red maple leaf
83
horse presents with exercise intolerance, brown MM, brown urine and the following blood smear was performed. What do you see in blood smear and what is likely cause
Blood smear: eccentrocytes
Cause: red maple leaf toxicity/ toxin causing intravascular hemolytic anemia
