Pale Mucous Membranes

Question 1

Identifying the problem for pale mm?

Answer 1

Poor peripheral perfusion or anemia

Question 2

CS of anemia

Answer 2

Hemorrhage
Hemolysis
BM failure
Pale mm

Question 3

CS of Poor peripheral perfusion

Answer 3

Heart failure
Shock
Dehydration

Question 4

Different classifications of anemia

Answer 4

Acute, regenerative or non-regenerative

Question 5

BM response

Answer 5

3-4 days
Full marrow response by 7 days

Question 6

Microcytosis

Answer 6

Small RBCs
From iron deficiency and partacaval shunt

Question 7

Macrocytosis

Answer 7

Large RBCs
From Regeneration*, breed effect (poodles), and FeLV

Question 8

Evidence of regeneration

Answer 8

Polychromasia (size variation), macrocytosis, poikilocytosis, reticulocytosis (retained nuclear material) , nucleated RBCs

Question 9

What is the best assessment of regeneration?

Answer 9

Reticulocyte count (corrected v uncorrected, absolute count)

Question 10

Cat reticulocytes

Answer 10

Punctate (mature, past regeneration, not included in reticulocyte count)
Aggregate (true indicator of recent regeneration)

Question 11

Nucleated RBCs (normoblasts)

Answer 11

More immature than reticulocytes (less of them)
Should be >1

Question 12

Appropriate normoblastemia

Answer 12

Intense regenerative anemia from blood loss and hemolysis
+ significant reticulocytes

Question 13

Inappropriate normoblastemia

Answer 13

More NRBCs than reticulocytes
Peracute anemia, splenic disorders (hemangiosarcoma), normal mini schnauzers and dachshunds, lead toxicity, BM disorders

Question 14

Cat normoblasts

Answer 14

Few, sometimes numerous in peripheral blood of sick cats (conditions other than lead toxicity)
Without evidence of intense erythrogenesis

Question 15

Hemolytic anemia classifications

Answer 15

Extravascular or intravascular

Question 16

Intravascular hemolysis

Answer 16

In centrifuged plasma
With Hburia
Jaundice common

Question 17

What causes hemolytic anemia?

Answer 17

Immune mediated
Microangiopathic (RBCs damaged)
Congenital (enzyme deficiency)
Infectious
Drugs/toxins (heinz bodies from garlic and onions)

Question 18

Hemorrhagic anemia causes

Answer 18

External: trauma, coagulopathy and bleeding lesion in GI or urinary tract
Internal: Trauma, hemangiosarcoma, coagulopathy

Question 19

Hemolytic anemia v internal hemorrhage

Answer 19

More regenerative than anemia due to external blood loss
Plasma protein levels normal or ↑ (hemolysis)

Question 20

What affects plasma protein levels?

Answer 20

Acute hemorrhage (↓)
Chronic external hemorrhage (↓)
Hemolysis (↑)

Question 21

What can cause Spherocytosis?

Answer 21

Immune mediated hemolysis
Mononuclear phagocytic neoplasm
Splenic pathology

Question 22

What can cause shistocytosis?

Answer 22

Blood forced through narrow passages (microangiopathy) → splenic damage, hemangiosarcoma, DIC, vasc. neoplasm, glomerulonephritis
Physically damaged (endocarditis)
Caval syndrome

Question 23

Acanthocytosis

Answer 23

Forms due to altered lipid: cholesterol ratios in RBC membrane
Associated with hemangiosarcoma, glomerulonephritis, lymphoma and hepatic disease

Question 24

Heinz bodies

Answer 24

Round structure from RBC or retractile spot in cytoplasm
Oxidation → denatured, precipitated Hb
If removed may leave spherocyte

Question 25

Heinz bodies will __________ RBC flexibility and cause ___________

Answer 25

1. ↓ 2. Intravascular hemolysis

Question 26

Heinz bodies in cats

Answer 26

Most common because more susceptible to oxidation (spleen less efficient @ removal) 10% of RBCs may contain HBs

Question 27

What causes heinz bodies in cats?

Answer 27

Onions, garlic, wilted red maple leaves, paracetamol (acetaminophen), propylene glycol and propofol

Question 28

Non-regenerative anemia

Answer 28

Anemia of chronic disease Renal failure Oestrogen toxicity Primary BM disorders: Red cell aplasia, myelophthisis, dyserythropoiesis Iron deficiency Immune mediated Hypothyroidism

Question 29

Most common cause of non-regenerative anemia

Answer 29

Anemia of a chronic disease Associated with inflamm or neoplastic disease