3.2 Hematology Anemia & Polycythemia

Front 1

What are examples that cause blood destruction?

Back 1

2HPT
・(Immune-mediated) Hemolytic Anemia
・Heinz body anemia
・(Zinc) Toxicosis
・(Hypo)phosphatemia
・(RBC) Parasites
・Thermal

Front 2

IMHA is often ___ to other disorders/events.

Back 2

Secondary

Front 3

1. IMHA is associated with __(3)__ in horses.
2. IMHA is associated with __(3)__ in cats.
3. IMHA is more common in ___.

Back 3

1. Clostridial infections, Penicillin, Neoplasia
2. Mycoplasma haemofelis, FeLV, Neoplasia
3. Dogs

Front 4

Highest incidence of IMHA in dogs is highest in (3 breeds)

Back 4

Cocker spaniel (Poodles & Collies)
(Cocker-Poodle doo (chickens rounded by Collies))

Front 5

Dx:
MCV:

Back 5

Dx: IMHA (spherocytes)
MCV: Normocytics (MCV normal in spherocytes)

Front 6

Anemia in animal was NON-REGENERATIVE so a BM aspirate was conducted.
Dx:
What supports your answer?
Why is it non-regenerative?

Back 6

Dx: IMHA (Polychromatophilic cells are being destroyed before going into circulation)
Support: Agglutination [TR] and mO engulfing RBC
Why? Polychromatophilic cells are also being destroyed & not released.

Front 7

Identify the structures:
1.
2.
Dx:

Back 7

1. Polychromatic cell
2. Platelets
Dx: IMHA

Front 8

What are Ddx for SPHEROCYTOSIS?

Back 8

・Previous mismatched blood transfusion
・Rattlesnake envenomation (→ echinocytes → spicules go away → spherocytosis)
・Bee stings (band 3 clustering)
・Heinz body anemia in horses
・Zinc toxicosis (→ △membrane Ag→ spherocytosis)

TB HRZ

Front 9

1. If there is no observable agglutination BUT suspecting IMHA, we may use the ___ to confirm.
2. Agglutination is when ___ is the antibody.
3. True/False. When agglutination is present macroscopically, then no Coomb's test is necessary.

Back 9

1. Coomb's test (Direct Antiglobulin Test (DAT)
2. IgM
3. True (automatically an IMHA)

Front 10

What are some disadvantages of using Coomb's test?

Back 10

Many false POSITIVES (Low sensitivity)
Many false NEGATIVES (Low specificity) ([L] of Ab on RBCs)

Front 11

How can we prevent false positives?

Back 11

Wash RBC's 3x (Reads immune complexes/Ab attached to erythrocytes but NO destruction)

Front 12

Is Coombs' test indicated?
Dx:

Back 12

No
IMHA

Front 13

What laboratory findings will be associated with IMHA?

Back 13

Thrombocytopenia
Leukogram: inflammation
+/- Azotemia (prerenal/renal (Hgb toxic to renal))

Front 14

What other diseases can result with thrombocytopenia?

Back 14

DIC (aPTT & PT prolonged)

Front 15

1. RBC production is stimulated by...
2. Leukocyte production is stimulated by...
3. What other dz. is usu. in conjunction with IMHA?
4. Animals with IMHA usually die from ___.

Back 15

1. EPO
2. Cytokines
3. DIC
4. Thromboembolism (assoc. w/ DIC)

Front 16

What other disease is concurrently associated with IMHA?

Back 16

DIC

Front 17

In summary, IMHA is associated with what findings?

Back 17

・Regenerative
・Spherocytosis
・+/- Agglutination (if IgM)
・nOilia + L-shift
・Thrombocytopenia

Front 18

What are Ddx for SPHEROCYTOSIS (BIHRT)?

Back 18

・Rattlesnake envenomation (Dogs) (→ spheroechinocytes → spicules go away → spherocytosis)
・Clostridial infections (Horses)
・Bee stings (band 3 clustering)
・Heinz body anemia (Horses) (membranes collapse (eccentrocyte)/band 3 clustering)
・Zinc toxicosis (→ band 3 clustering → spherocytosis)

Front 19

What is band 3?

Back 19

A major erythrocyte membrane-spanning protein that is responsible for mediating the exchange of chloride (Cl-) for bicarbonate (HCO3-). When clustered, they provide the recognition site for Abs.

Front 20

1. What is neonatal isoerythrolysis?
2. What other signs are associated with neonatal isoerythrolysis?

Back 20

1. Maternal Ab made against the neonates blood group Ab → RBC hemolysis.
2. Hemoglobinemia, Hemoglobinuria, Splenomegaly, Thrombocytopenia, DIC (BF of IMHA)

Front 21

1. Which erythrocyte parasites mechanically cause IV hemolysis?
2. How do the other erythrocyte parasites cause anemia?

Back 21

1. Theileria & Babesia
2. By immune-mediated mechanisms (Ab → parasite → complement fixation/phagocytosis → RBC destroyed)

Front 22

What erythrocyte parasite is the most COMMON and serious cause of severe anemia?

Back 22

Mycoplasma haemofelis (T: blood (iatrogenic), arthropods, cat bites, vertically)

Front 23

1. Identify the parasite.
2. If anemia is NON-REGENERATIVE, what tests are indicated?

Back 23

1. Parasite: Mycoplasma haemofelis (usu. Reg. anemia)
2. FeLV/FIV

Front 24

What factors predispose animals to Mycoplasma haemofelis?

Back 24

Concurrent disease
Immunosuppression (severe)
Splenectomy

Front 25

Identify the structures/parasites:
1.
2.
What factors predispose animals to Mycoplasma haemocanis?

Back 25

1. Mycoplasma haemocanis (opportunist)
2. Howell's Jolly Body (nucleus remnant)
Factors: Immunosupression (severe), Splenectomy

Front 26

Identify the parasite:
1.
What differentiates this parasites from other erythrocyte parasites?
What is the common method of transmission?

Back 26

1. Mycoplasma wenyonii
Differentiation: M. wenyonii circulates freely or falls off RBC immediately
T: Iatrogenic

Front 27

Identify the parasite/structure:
1.
2.
Is #2 normal/abnormal in RUMINANTS ?
Is #2 normal/abnormal in SMALL ANIMALS?

Back 27

1. Mycoplasma ovis (Big O)
2. Basophilic stippling
Ruminants: Normal (common with regenerative anemia)
Small Animal: Abnormal (associated with Pb poisoning)

Front 28

Identify the parasite/structure:
1.

Back 28

Mycoplasma haemolamae (opportunist)

Front 29

What is the cause of:
Severe anemia in baby pigs
Poor weight gain in adult pigs

Back 29

Mycoplasma haemosuis

Front 30

What TICK-BORNE rickettsial infections (2) cause FATAL HEMOLYTIC ANEMIA (esp. older animals) by immune-mediated destruction?

Back 30

Anaplasma marginale [picture]
Anaplasma centrale

Front 31

Identify the parasite/structures on this cow's blood film:
1.
2.
3.

Back 31

1. Polychromatic cell
2. Basophilic stippling
3. Anaplasma marginale (in large #'s)

Front 32

What TICK-BORNE erythrocyte parasite mechanically causes IV hemolysis (→ hemolytic anemia) and is fairly toxic esp. in cats?

Back 32

Babesia

Front 33

What disease can be mistaken for IMHA and can be identified by its TEAR-DROP shape?

Back 33

Babesiosis

Front 34

Identify the parasite/structure indicated by the small arrows/arrow-head in this blood film:
Small arrows/arrow-head:

Back 34

Small arrows/arrow-head: Babesia

Front 35

1. What other erythrocyte parasite mechanically causes IV hemolysis → hemolytic anemia in ruminants (esp. in CATTLE)?
2. What stage of this organism is within RBCs?

Back 35

1. Theileriosis
2. Merozoite (piroplasm)

Front 36

FYI: Sickle cells occurs in vitro due to the presence of...

Back 36

air (no significance)

Front 37

An important emerging infectious protozoan in domestic cats that is transmitted by ticks and is almost ALWAYS FATAL.

Back 37

Feline cytauxzoonosis

Front 38

1. What are heinz bodies?
2. What animal is most susceptible to the anemia?
3. Name 3 diseases that this anemia occurs with in cats (DHL).

Back 38

1. Oxidatively denatured hemoglobin
2. ***Cats***
3. DM, HyperTHYROidism, Lymphoma

Front 39

Dx the condition:
What stain is used to confirm the presence of these structures?

Back 39

Dx: Heinz Body Anemia
Stain: New Methylene Blue

Front 40

What is methemoglobinemia?

Back 40

Abnormal hemoglobin in which the Fe of the unoxygenated hemoglobin is in the FerrIC (germaphobe) state rather than the ferrous state (ferric = unable to carry O2/CO2).

Front 41

Some drugs & chemicals → heinz body anemia also cause ___.

Back 41

methemoglobinemia (see in conjunction)

Front 42

Name some PLANTS that may cause Heinz body formation:

Back 42

・Onions, Garlic (Allium family)
・Cabbage, Kale, Rape (Brassica)
・***Wilted red maple leaves***

Front 43

Name some DRUGS/CHEMICALS that may cause Heinz body formation:

Back 43

・Acetaminophen (cats)
・Propylene glycol (NOT ETHYLENE; cat food)
・Zinc
・Cu Se deficiency
・Crude oil
・Moth balls (Naphthalene)

Front 44

What are 2 ways hemoglobin can be oxidized?

Back 44

1. Hemichrome formation (→ aggregates of denatured Hgb)
2. Oxidative damage to sulfhydral groups (CATS more susceptible)

Front 45

Hemichromes complex with ___ resulting in ___ sites for auto-antibodies (cell removed by spleen). This may also lead to the formation of ___.

Name 2 items that may cause the formation of these heinz bodies.

Back 45

Band 3/Recognition/Spherocytes
2 causes: Zn toxicosis, Wilted red maple leaf toxicosis

Front 46

Name some PLANTS that may cause methemoglobinemia:

Back 46

***Wilted red maple leaves***

Front 47

Name some DRUGS/CHEMICALS that may cause methemoglobinemia:

Back 47

・Acetaminophen (Cats)
・NitrITE poisioning (Cows; Nitrates → Nitrites (Toxic))

Front 48

Name a CONGENITAL DEFICIENCY that may cause methemoglobinemia:

Back 48

NADH-methemoglobin REDUCTASE (enzyme that converts methemoglobin to hemoglobin)

Front 49

Pulled blood that appears chocolate brown. What is this diagnostic of?

Back 49

Methemoglobinemia (→ ↑free O2 → ↑O species → Heinz body formation)

Front 50

What metal accumulates in LIVER of SHEEP (most susceptible) and during stress → heinz body formation?

Back 50

Copper (Cu toxicosis)

Front 51

Heinz body in (animal) formation arises from ___.
Cats
Sheep
Horse
Cattle

Back 51

・Acetaminophen
・Cu Toxicosis
・Wilted red maple leaves
・Nitrite poisoning

Front 52

Deficiency in the mineral ___ leads to HEMOLYSIS.

Back 52

Phosphorus (hypophosphatemia; ATP is required for normal red blood cell membrane integrity)

Front 53

Hypophosphatemia → ___ → ___
What are some causes of hypophosphatemia?

Back 53

↓ATP (req'ed for norm RBC membrane integrity)/hemolysis
Causes:
Postparturient hemogobinuria (CATTLE; due to Ketones)
DM & Enteral alimentation (CATS)

Front 54

How do ketones causes heinz body formation?

Back 54

Oxidative damage to hemoglobin.

Front 55

___ & ___ are 2 bacteria that can cause HEMOLYSIS.

Back 55

Clostridium spp. (Lecinthinase → lysis)
Leptospira spp. (RARE)

Front 56

(Name of agent) IS TO (Disease) as:
Clostridium perfringins Type A IS TO
Clostridium haemolyticum IS TO

Back 56

・"Yellow lamb disease" (LAMBS & CALVES = young)
・"Bacillary hemoglobinuria/Red water disease" → associated with liver fluke migration (CATTLE)

Front 57

Unlimited water access (cattle/calves (usu.)) → HEMOLYSIS. Why? What is this condition called? In what animals may this be more severe?

Back 57

↓Osmolality of plasma → H20 moving into RBC.
Condition: Water intoxication
More severe in: Fe deficiency anemic animals (CALVES)

Front 58

What INHERITED membrane defect is known to occur in Miniature Schnauzers & Alaskan Malamutes?

Back 58

Hereditary stomatocytosis

Front 59

What enzyme deficiencies contribute to hemolytic anemia?

Back 59

・glucose-6-phosphate dehydrogenase (G6PD) (import. for NADPH)
・Pyruvate Kinase (PK) deficiency in dogs/cats (import. for glycolysis)
・Phosphofructokinase (PFK) deficiency (import. for glycolysis)
・Uroporphyrinogen III co-synthetase

Front 60

What breeds (DOGS) are more susceptible to Pyruvate Kinase (PK) deficiency?
Why does this deficiency lead to HEMOLYTIC ANEMIA?

Back 60

Basenji, Beagles, West Highland White Terrier, Cairn Terrier
MOA: Lack of ATP → abnormal RBC membrane integrity → DEATH by age 4

Front 61

What breeds (CATS) are more susceptible to Pyruvate Kinase deficiency (PK)?
How is a deficiency in cats different from a deficiency in dogs?

Back 61

Abyssinian, Somali, DSH
Difference: Cats can live to old age. Dogs die by age 4.

Front 62

What breeds (DOGS) are more susceptible to Phosphofructokinase (PFK) deficiency?

Back 62

English Springer Spaniel dogs (PCV= WRI but hemolytic crises when ALKALEMIC)

Front 63

The deficiency of ___ → inability to synthesize hemoglobin (spec. Heme)
What does this lead to?

Back 63

Uroporphyrinogen III co-synthetase
Outcome: ↑UROporphyrin & COPROporphyrin (bones & teeth → fluorescence & photosensitivity) and ***↓RBC survival***.

Front 64

What do we see in PIGS & CATS with uroporphryinogen III co-sythetase

Back 64

PIGS: No photosensitization
CATS: No anemia

Front 65

What are our options for a non-regenerative anemia/↓production of RBCs?

Back 65

**EARLY** = Blood loss/Destruction
Late = Chronic Ehrlicia, Neoplasia, Toxin

Front 66

MCV = HIGH (macrocytosis)
Non-regenerative anemia
In a cat these values suggest:

Back 66

FeLV (otherwise tends to be normocytic)

Front 67

What 2 readings tend to be useless with a non-regenerative anemia?
What 2 diagnostic tools may we need to look at to find out what the issue is?

Back 67

・MCV (tends to be normocytic)
・RBC morphology (tends to be normal)
・Diagnostic tools: Biochemical profile, BM aspirate

Front 68

If anemia originates from RBC production then, what will we see in the diagnostic tests?

Back 68

Hypoplasia (↓RBC production)
Aplasia (No RBC production)

Front 69

↓RBC (Hypoplasia)
Neutropenia
Thrombocytopenia
Non-regenerative anemia
Values suggest:
What type of anemia is this?

Back 69

Anemia originates from BM
Aplastic Anemia (General Marrow Suppression)

Front 70

What are Ddx for APLASTIC anemia (General Marrow Suppression)?

Back 70

・Immune-mediated destruction (early; confirm w/ GC)
・Ehrlicia, FeLV (macrocytosis)
・Drugs & chemicals

Front 71

Name some DRUGS/CHEMICALS that cause Aplastic Anemia (General Marrow Suppression).

Back 71

・Anti-neoplastic/Immunosuppressive drugs
・Toxins: solvent/household cleaning agents (Dogs/Ferrets)
・Estrogen: granulosa cell tumors, sertoli cell tumors, unspayed F ferrets (Dogs/Ferrets)

Front 72

How often do we see Erythroid Aplasia (Pure Red Cell Aplasia)?
What are the 2 main causes of Erythroid Aplasia?

Back 72

Occurrence: Rare
Causes: Immune-mediated destruction of RBC precursors (NO DRUGS/CHEMICALS) & FeLV

Front 73

What DRUGS/CHEMICALS cause Erythroid Aplasia?

Back 73

NONE. Always think immune-mediated.

Front 74

Non-regenerative anemia with Erythroid Hypoplasia can be ___ OR ___.

Back 74

Intrinsic/Extrinsic

Front 75

Name some INTRINSIC factors that contribute to Erythroid Hypoplasia in non-regenerative anemia.

Back 75

・Myelodysplasia (ineffective production of the myeloid class of blood cells)
・Leukemia (type of cancer of the blood/BM)
・Immune-mediated destruction of erythroid precursors.

LIM

Front 76

Name some EXTRINSIC factors that contribute to Erythroid Hypoplasia in non-regenerative anemia.

Back 76

Chronic Renal disease
Inflammatory disease
Endocrine disorders (hypothyroidism/adrenocorticism = ↓RBC prod.)

ERI

Front 77

The most important EXTRINSIC factor that contributes to Anemia of Renal Disease is the insufficiency of ___.

Back 77

EPO (anemia of renal disease)

Front 78

What diagnostic assessment will help us diagnose an anemia of inflammatory disease?

Back 78

↑storage Fe (inflammatory dz anemia (Regen.) may be superimposed over Fe deficiency anemia (non-Regen.))

Front 79

What are the 2 Fe storage complexes?
What is the difference?
What is hepicidin?

Back 79

Fe storage complexes: Hemosiderin & Ferritin
Diff.: Hemosiderin (insoluble) & Ferritin (soluble)
Hepicidin: Hormone that regulates Fe hemostasis

Front 80

Overall what do we see with Anemia of Inflammatory Disease?

Back 80

↑storage Fe → ↓Fe transport & functional pools (limit to EPO)