Lecture 6 - non regenerative anemias Flashcards Preview

Clinical Pathology Exam 1 > Lecture 6 - non regenerative anemias > Flashcards

Flashcards in Lecture 6 - non regenerative anemias Deck (59):
1

nonregenerative anemias __ are minimal or absent and is often has normal __ and __ values (except iwth deficiencies like iron)

polychromasia/reticulocytosis, MCV (normocytic) and MCHC (normochormic)

2

are clinical signs of anemia present with nonregenerative anemias

absent or mild

3

__ can cause selective depression of EPO which cuases BM activity reduction and RBC maturation defects

systemic dz outside the BM (extramarrow dz)

4

inadequate or abnormal hematopoiesis due to __ causes a reduction of all cell types

primary BM dz (intramarrow dz)

5

what non-regenerative anemia would you expect to see only anemia (only RBC decreased)

extramarrow/systemic dz

6

List the humoral factors that support RBC production in BM

1. EPO (kidney)
2. Iron (liver)
3. endocrine hormones (pituitary, thyroid, glucocorticoids, androgens)

7

Do you need to collect a BM sample to dx cause of nonregenerative anemia?

NO, can rule out systemic dz (renal/liver dz, inflammation, extramarrow cancer, endocrine disorder)

8

patients with __ renal failure are anemic, while patients with __ renal failure are usually NOT anemic

Chronic (>100days), acute

9

blood smear findings with chronic renal dz nonregenerative anemia

mild to moderate, normocytic, normochromic, nonregenerative anemia. serum/urine chem changes consistent with renal dz

10

what is the MOST COMMON nonregenerative anemia of domestic animals

anemia of chronic inflammatory dz

11

__ released with inflammation make the BM nonresponsive to EPO

inflammatory cytokines

12

most __ have infalmmatory components

chronic dz
nonifections -IM, neoplastic, toxic or
infectious - bact, fungal, viral, protozoal

13

The clinical signs seen with anemia of inflammatory dz are caused by

underlying dz, NOT the anemia (anemia will improve when dz is treated)

14

Cytokines released during inflammation cause __ to be stored (not available to make RBC) which impairs BM repsonse to EPO and shortens RBC survival

iron

15

blood smear/lab findings with chronic inflammation nonreg anemia

1. mild to mod, normocytic/chromic, nonregenerative anemia with LITTLE OR NO Poikilocytosis (abnormal shaped cells)
2. chronic inflamm leukogram
3. hyperglobulinemia (intravascular hemolysis)
4. decrease in serum iron

16

__ is a protein that binds stored iron putting it on "lock down", the stored iron is found in what organs. __ is a protein that carries iron around the body but this is decreased with inflammation nonreg anemia

ferritin, BM and spleen, transferrin

17

What anemia looks similar to iron deficiency anemia?

nonreg anemia of chronic inflammatory dz

18

chronic liver dz causes

functional iron deficiency due to transferrin protein not being made by liver = iron can't be transported to the BM for RBC production. Have the Iron just can't use it.

19

blood smear/lab findings with chronic liver dz nonreg anemia

1. mild to moderate, normocytic, normochromic, nonregnerative anemia
2. Poikelocyte = Acanthocytes (uneven spicules)
3.. low MCV or MCHC occationally seen (due to Hgb:SA ratio)
4. serum/urine biochem seen with liver dz.

20

Poikelocyte seen with non reg chronic liver dz anemia

acanthocytes

21

__ and __ are common endocrine def in older dogs and can cause endocrine def nonreg anemia

hypothyroidism, hypoadrenocoritcism (addison's)

22

hypoadrenocoritcism (Addison's dz) causes def of what important hormones to RBC formation

glucocorticoids and minerocorticoids

23

nutritional deficiency that leads to RBC maturation defect anemia (less common, seen more in LA and with unbalanced homecooked diets)

1. iron deficiency, more often due to blood loss than nutrition though
2. trace mineral def = abnormal heme (copper, molybdenum, vit B6) and nuclear maturation (folate, cobalamin, cobalt)

24

hereditary defect in poodles where they have normal __ RBC

macrocytic (hereditary macrocytosis)

25

3 things that cause RBC maturation defect

1. iron deficiency
2. lead poisoning
3. FeLV cats (macrocytic)

26

__anemia is a complication of chronic external blood loss (hemorrhage), except in piglets where it is a __ def

iron deficiency, nutritional

27

blood smear results for Fe def anemia

microcytic, hypochromic, +/- schistocytes (due to increased RBC fragility), Thrombocytosis

28

iron def anemia what should you look for

blood sucking parasites, bleeding GI or UG lesions

29

Chronic blood loss causes Fe def resulting in

anemia and RBC fragility

30

__ develops in Fe def anemia bc the amount of Fe left is inadequate for incorporation into heme for Hgb formation

hypochromasia

31

Severe Fe def anemia vs initial Fe def anemia blood smear results

severe = microcytic, HYPOchromic
initial = microcytic, NORMOchromic

32

__ is a beta-globulin protein made by the liver that binds/transports Fe and correlates with the TIBC

Transferrin
TIBC = total Fe binding capacity

33

__ is protein found inside cells and in low [plasma] that binds Fe for storage (BM and spleen)

Ferritin

34

where is iron stored

BM and spleen

35

plasma ferritin correlates with __ and can use prussian blue stain to evaluate BM fe stores

total body iron stores

36

In about 50% of iron def anemia cases will see __

thrombocytosis (increased platelets)

37

blood smear findings with Fe def anemia

crazy looking slide!
microcytosis
hypochromasia (severe)
increased RBC fragility (poikelocytes - schysotcytes, keratocytes, acanthocytes)
thrombocytosis (increased platelets)

38

Do not confuse the blood smear of Fe def anemia with

other life threatening fragmentation hemolysis (DIC, HW dz, glomerulonephritis, hemangiosarcoma)

39

How do you differentiate Fe def anemia from life threatening fragmentation hemolysis anemia

Fe def anemia= thrombocytosis
frag anemia = thrombocytopenia

40

with external blood loss will see __ and __

panhypoproteinemia (low albumin and globulins) and anemia

41

thrombocytopenia is seen with __ and __ (life threatening fragmentation hemolysis!)

DIC, hemangiosarcoma

42

__ can be seen early on in Fe def anemia but as Fe diminishes anemia becomes nonregenerative

polychromasia

43

lab findings for Fe def anemia

1. low [serum Fe]
2. norm/high TIBC (transferrin measurement - liver is still working)
3. low saturation of transferrin with iron (not enough Fe)
4. decreased serum ferritin (storage form)

3 and 4 are how ddx between Fe def and anemia of inflamm

44

How do you ddx between Fe def anemia and anemia of inflammatory dz (AID)?

decreased serum ferritin (storge Fe) and serum TIBC
Fe def lab results will show low saturation of transferrin:Fe (there is transferrin but not enough Fe)

45

HCT, MCV, and Serum Iron are __ in both iron def and AID anemias

decreased

46

Serum TIBC is __ in Fe def anemia and __ in AID

Fe def: normal to increased
AID: Normal to decreased

47

Serum ferritin is the best way to ddx between Fe def and AID, in Fe def it is __ and AID it is __

Fe def: decreased
AID: Norm to increased

48

increased nRBC are seen commonly in __

chronic lead poisoning (but can be due to other causes as well!)

49

normal __ maturation of RBC should see more mature cells than immature cells in circulation

pyramidal

50

__ is seen in lead poisoning along with certain other dz that cause non pyramidal maturation of RBC allowing more nRBC than polychromatophils in circulation

aberrant metarubricytosis

51

hallmark of lead poisoning

metarubricytosis (increased nRBC) WITHOUT polychromasia

52

other causes of aberrant metarubricytosis (increased nRBC) besides lead poisoning

1. trauma/ischemia
2. acute tissue anoxia (heat stroke, hypotension, choking, post-anesthetic crisis)
3. BM dz/cancer
4. cancer of RBC
5. drugs (chemotherapeutics)
6. extramedullary hematopoiesis

53

pathogenesis of chronic lead toxicity

lead interferes with Hgb synthesis and causes marrow stromal damage

54

response to chronic lead toxicity

disordered regenerative response (mostly nRBC, basophilic stippling, with no/little polychromasia)

55

in intramarrow dz list the decrease of cell lines from first to disappear to to last

neutrophils (10hr life) - platelets (10 d life) - RBC (100 d life)
cells with shorter life decrease first

56

since multiple cell lines may be affected by IM dz p may be at risk for

infection (leukopenia) and hemorrhage (thrombocytopenia)

57

most common immune mediated dz

NON-REGENERATIVE IMHA (BM or precursor cells effected)

58

4 things that can cause nonregen IMHA

1. Marrow replacement (neoplasia or fibrosis)
2. infectious dz (FeLV, parvo)
3. drugs, toxins (bracken fern)
4. radiation

59

2 reasons why TP can be high when PCV is low

dehydration and INFLAMMATION