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80 Cards in this Set
- Front
- Back
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Why do reticulocytes appear more blue on a blood smear?
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retention of RNA and organelles
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In cats, what is indicative of a regenerative response?
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aggregrate reticulocytes
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What type of anemia results in a greater regnerative response?
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lysis - due to availability of blood loss
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When is the initial and peak regenerative response?
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initial - 2-4 days
peak - 4-7 days |
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Other than anemia, why might nRBC be present in circulation?
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1 - lead tox
2 - splenic disease or spenectomy 3 - hypoxia 4 - bone marrow disease 5 - erythroleukemias |
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How long does it take fluid to shift from the extra to intravascular compartment with blood loss?
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8-12 hours
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Why do you need to know drug history when dealing with cases of anemia?
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1 - GI bleeding
2 - drug reaction 3 - BM suppression |
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What are some cardiorespiratory signs of anemia?
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- tachycardia
- tachypnea - excercise intolerance - heart murmur due to decreased blood viscosity |
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What are CS of hemolysis?
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1 - icterus (also seen with hepatic failure)
2 - splenomegaly/hepatomegaly (also seen with ruptured spenic mass and sequestration of RBCs) 3 - hemoglobinuria |
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What specific diseases in the dog might be associated with anemia?
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-splenomegaly
-hepatomegaly -test. tumor -ticks - lymphadenopathy |
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What are causes of intravascular hemolysis in the dog/cat?
Name 6 |
1 - IMHA (minor)
2 - Babesia 3 - Zinc/Copper tox 4 - decreased Phosphate 5 - Microangiopathic anemia 6 - Inherited RBC abnormalities |
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What are causes of extravascular hemolysis in the dog/cat?
Name 4 |
1 - IMHA (most)
2 - Mycoplasma haemofelis 3 - Cytauxzoon felis 4 - Heinz Body Anemia due to oxidative damage |
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What specific drugs can cause Heinz Body Anemias?
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-acetominophen, benzocaine, methylene blue, Vit K, DL-methionine
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What diseases in cats cause Heinz Bodies, but NOT anemia?
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- DM, hepatic lipidosis, hyperthyroidism
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What are the 5 causes of extramarrow non-regenerative anemia?
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1 - anemia of chronic disease (MOST COMMON CAUSE OF ANEMIA IN DOG AND CAT)
2 - renal failure 3 - endocrine disease (hypothyroid, hypoadrenocorticism, estrogen tox) 4 - nutritional def 5 - acute loss or lysis |
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What infectious diseases could cause marroe disease?
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-ehrlichiosis
FeLV, FIV |
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What 7 things could cause marrow disease?
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1 - infectioius agents
2 - Toxins or drugs 3- immune mediated (RBC aplasia or destruction of RBC precursors) 4 - marrow neoplasia 5 - myelodysplasia 6 - myelofibrosis 7 - BM necrosis |
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What disease should you consider in cats when there is macrocytosis without a regenerative response?
- macrocytic normochromic anemia |
FeLV
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What percentage of IMHA cases are primary?
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>60-70%
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What are 3 main causes of secondary IMHA?
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1 - neoplasis
2 - drugs 3 - infection |
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What infectious agents are associated with IMHA?
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-Mycoplasma haemofelis
-Babesiosis |
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What is the basic pathophysiology of extravascular lysis?
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antibodies (IgG and IgM or circulating immune complexes attach to RBC and marcophages in spleen and liver have receptors that bind to the Fc portion of antibodies
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What is the typical signalment of canine IMHA?
Is it an acute or chronic problem? |
- Cocker Spaniel
-6-8 y/o -F>M acute |
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What percentage of canine IMHA cases are icteric?
What percentage of canine IMHA have autoagglutination? |
50%
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What is present in the blood smear with IMHA?
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spherocytes
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Other than anemia, what is common with IMHA on a CBC?
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-leukocytosis sometimes with a left shift
- thrombocytopenia --> possible due to concurrent IM thrombocytopenia OR DIC |
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Other than anemia, what is common with IMHA on a blood chemistry?
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-hyperbilirubinemia (70%)
-elevated liver enzymes are common |
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Why are liver enzymes elevated with IMHA?
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- increased bilirubin metabolism
-hepatic damage due to DIC -DIC |
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Diagnosis of IMHA should have regenerative anemia with evidence of hemolysis plus one + of the following:
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1 - Spherocytosis
2 - Autoagglutination 3 - Positive Coombs |
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What does a direct coomb's test for?
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antibody (IgG and IgM) and complement on the patient's RBCs
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What are complications of IMHA?
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-concurrent IM thrombocytopenia
-DIC -Thromboembolism |
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What is the treatment for IMHA?
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-treat for underlying disease or discontinue drugs
-immunosuppressive dose of prednisone (2-4 mg/kg/day) -evidence of response is stable PCV and reduction of spherocytes |
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When should you begin to taper prednisone?
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when the PCV is 30-35% and no evidence of hemolysis on the blood smear
-reduce dose by 25-33% every 2-4 weeks |
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When should prednisone be discontinued when treating IMHA?
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if PCV is normal after 4 weeks on a low, every other day dose of pred
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When is a blood transfusion recommended with IMHA?
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- when PCV < 15%
-clinical signs of anemia regardless of PCV |
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What type of transfusion would you give with anemia?
What type with DIC? |
anemia - packed RBCss
DIC - plasma |
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What is frequently used to treat IMHA to prevent thrombosis or DIC?
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aspirin
-give fluids if DIC is present or expected |
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What drugs are most common to cause IMHA?
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-methimazole, cephalosporins, sulfonamides
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What is a cause of neonatal death/fading kitten syndrome?
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neonatal isoerythrolysis
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What is the agent that causes Hemobartonellosis (Feline Infectious Anemia)?
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Mycoplasma haemofelis
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What condition might you want to check if you know that the dog has M. haemocania and has anemia?
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has it been splenectomized
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Up to 50% of cats with clinical disease of M. haemofelis are positive for what disease?
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FeLV
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Hemolysis is extravascular with M. heamofelis via spenic removal. What is this caused by?
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- the parasite
-and an immune mediated mechanism (Ab against parasite on RBC membrane) |
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What is unique about the CS of M. heamofelis?
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episodic fever AND parasite can be hard to see on smear as parasitemia is intermittent (visible in only 50% of smears during an acute infection)
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If a blood smear is negative for M heamofelis, what other test can be done?
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PCR although positive PCR does not mean that it is positive for the organisms
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What is the treatment for M heamofelis?
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-doxycycline or tetracycline for 3 weeks (alternatively enrofloxacin)
- prednisone with severe anemia to halt IMHA |
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How is Babesia canis or gibsoni transmitted?
M. heamofelis? |
ticks, blood transfussions
- arthropods, bits, in utero, lactation |
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What dogs are predisposed to Babesia?
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-greyhounds (subclinical carrier state is very common), dogs less than 1 year of age
-pitbulls to B. gibsoni - in animals living along the Gulf States |
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What are the 2 forms of Babesiosis?
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1 - Hemolytic anemia - acute or chronic --> with autoagglutination, thrombocytopenia
2 - peracute form --> shock, multiple organ failure, DIC, hemoglobinuria |
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Where should you collect blood from to ID babesia?
If you can't find the organisms here, what test is most reliable? |
capillary blood - eaar tip or nail
- IFA - false neg CAN occur |
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What is the treatment for Babesia?
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single treatment of Imidocarb diproprionate -- more effective against B. canis
- more effective is Diminazene aceturate, but not available in the use - CLindamycine may have some effect |
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What type of parasite is Cytauxzoon felis?
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protozoa transmitted via ticks esp in SE and southern
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What two pathogenic factors cause the clinical signs of cytauxzoon felis?
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1 - proinflammatory substances --> fever, inflammation, DIC
2 - infects RBCs --> hemolysis |
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What type of anemia might there be initially with c. felis?
What other CBC data might there be? |
non-regenerative anemia
-leukocytosis and thrombocytopenia because of extreme inflammation and DIC |
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What is the treatment for C. felis?
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Diminaze aceturate or imidocarv diproprionate
-supportive care for DIC if present |
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What are the 3 forms of oxidaive injury to hemoglobin?
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1 - methemoglobinemia - reversible
2 - heinz bodies 3 - membrane injury |
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What is the most common cause of methemoglobinemia?
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acetominophen
- hemoglobin can't find and carry oxygen |
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What cells are often present with membrane injury --> membrane lipid peroxidation, cross-linking, impaired ion transport
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eccentrocytes
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What might cause membrane injury?
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zinc, naphthalene, copper tox.
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What is the treatment for oxidative injury anemia?
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methemoglobinuria - mehylene blue IV acts as electron donor
N-acetylcystine for acetaminophen toxicity (sulfate conjugates acetaminophen and cystein for glutathione regeneration) |
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Other than anemia, what signs are seen with zinc toxicity?
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GI
CBC - spherocytes, eccentrocytes, ghost cells, target cells, Heinz Bodies |
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What is the pathogenesis of anemia due to chronic renal failure - a normocytic, normochromic nonregenerative anemia
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1 - decreased EPO secretion
2 - decreased life of RBCs 3 - impaired BM response to EPO 4 - GI blood loss due to uremic gastritis |
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How do you treat anemia due to chronic renal failute?
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give human recombinant EPO
SQ 3 x per week until PCV > 35 and > 30 in dog and cat resp. -oral iron |
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What happens in 25-50% of the cases that are given human recombinant erythropoietin?
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develope anti-erythropoietin antibodies that block the action of the human product but these don't cross-react with endogenous EPO
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What is nonregenerative IM anemia?
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bone marrow disease where immune response is against RBC precursors
- 50% Coombs test positive -Spherocytes may be prewent |
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What is the prognosisis and treatment for bone marrow diseae?
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- immunosuppressive treatment
- 50% have resolution |
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What CBC feature will you see with aplastic anemia?
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pancytopenia/failure of BM
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What is myelodysplasia?
Myeloproliferatrive Disease? |
infective erythopoiesis and or production of WBCs
- neoplasia of the BM \ |
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When is a blood transfusion needed with anemia?
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- with CS
- PCV < 10% -acute loss will need when PCV is higher -must do before thrombosis or organ damage/failure |
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What factors are are inactive 6 hours after collection ?
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CF 5 and 8; von Willebrand factor, platelets, WBCs
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What type of blood would you use if you had anemia with a coagulopathy?
w/o coagulopathy |
fresh whole blood
Packed RBCs |
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Why are packed RBCs important in renal failure, heart failure?
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reduces expansion volume as occurs with concurrent plasma administration
-also min. risk of reaction due to plasma |
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What DEA type is the most important and what DEA type is the most antigenic?
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1
1.1 - anti antibodies can develop within 5 days |
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A universal donor dog is negative for what?
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DEA 1.1, 3, 5, 7
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What are the 3 feline blood types?
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A, B, AB
- A is dominant over B |
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What is the most dominant blood type of cat?
Which blood type would have the stonger reaction if given the wrong blood? |
A
type B |
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What does a major crossmatch test for?
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alloantibodies in recipient plasma against donor RBC
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What is the equation for blood dose for transfusionts?
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(Desired PCV - Patient PCV) x normal PCV x Body weight (lbs)/ donor blood PCV
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How much will the PCV increase if 2ml/kg of donor blood with a PCV of 40%?
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1%
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What is the standard rate for a blood transfusion in normovolemic animals?
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5-10 ml/kg/hr with a max of 20
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