RBC Cases

This is the erythrogram from one of the dogs presented for 3^rd year surgery, also included is an image from your patient’s blood smear. Use this information for Questions1-4.

	Result	Ref Range
RBC	5.18M/uL	5.65-8.87
HCT	30.0%	37.3-61.7
HGB	11.0 g/dL	13.1-20.5
MCV	57.9 fL	61.6-73.5
MCH	21.2 pg	21.2-25.9
MCHC	30.8 g/dL	32-37.9
%Retic	0.8%
Retic	42.5K/uL	10.0-110.0

How would you characterize the anemia?

Mild, regenerative, microcytic, hypochromic

Mild, non-regenerative, microcytic, hypochomic

Mild, regenerative, macrocytic, hypochromic

Mild, non-regenerative, macrocytic, hyperchromic

Mild, non-regenerative, microcytic, hypochomic

Which etiology is the best fit for this pattern (Refer to data/image in question 1)?

Acute hemorrhage

Chronic inflammation

Immune-mediated hemolytic anemia

Iron-deficiency anemia

Iron-deficiency anemia

Reasoning: low MCV, low MCHC, low retic support iron-deficiency; IMHA, hemorrhage, inflammation  would be normocytic, normochromic;

This patient is an adult dog.  Refer to data/image in Question 1. What is the most likely etiology?

Hookworm infestation

Internal bleeding from a splenic hemangiosarcoma

Renal disease

Nutritional deficiency

Hookworm infestation

How would you describe this cell which predominates in your patient’s smear?

Spherocyte

Platelet

Normal RBC

Hypochromic RBC with increased central pallor

Hypochromic RBC with increased central pallor

reasoning; lack of color in middle, ormally a pale pink spot instead of almost translucent

A 15-year-old FS cat is presented for annual wellness screening.  She is underweight with mild muscle wasting.  On abdominal palpation her kidneys feel a little small bilaterally, but otherwise unremarkable.  Her erythrogram is below.  Use this information for questions 5-7.

	Result	Ref Range
RBC	5.2 M/uL	6.54-12.20
HCT	27 %	30.3-52.3
HGB	9.6 g/dL	9.8-16.2
MCV	37.0 fL	35.9-53.1
MCH	12.5 pg	11.8-17.3
MCHC	30.1 g/dL	28.1-35.8
%Retic	0.2%
Retic	22.0 K/uL	3.0-50.0

How would you describe the findings of the erythrogram?

Mild, non-regenerative, normocytic, normochromic anemia

Marked, non-regenerative, microcytic, hypochromic anemia

Mild, regenerative, normocytic, normochromic anemia

Moderate, regenerative, microcytic, hypochromic anemia

Mild, non-regenerative, normocytic, normochromic anemia

What is the main mechanism for anemia in cats with chronic renal disease?

Decreased erythropoietin production

Increased phagocytosis of RBC in the glomerulus

Oxidative RBC damage by high levels of urea

Renal blood loss

Decreased erythropoietin production

reasoning; · 

Erythropoietin (EPO) is a hormone made by peritubular interstitial cells in the kidney.

·  In chronic renal disease, progressive fibrosis and loss of functional renal tissue leads to inadequate EPO synthesis.

·  Without enough EPO, the bone marrow isn’t stimulated to produce new red blood cells → results in a non-regenerative anemia

Which other cause of anemia would have a similar pattern to the erythrogram presented in Question 5?

Anemia of inflammation

Immune-mediated hemolytic anemia

Chronic flea infestation anemia

Iron deficiency

Anemia of inflammation

reasoning; IMHA and fleas typically regenerative; iron deficiency microcytic/ hypochromic

A 3-year-old Thoroughbred gelding is presented for pre-purchase evaluation.  The horse has been trailered to your clinic and when you look inside the trailer you notice that the water bucket is empty.  You perform abbreviated bloodwork and make a blood smear.  Results are below. Use this information for questions 8-10.

	Result	Reference Range
RBC	12.4 M/uL	6.4-10.4
PCV	54 %	3-47
TP	8.8 g/dL	5.6-7.9

What is the most correct interpretation of these results?

Polycythemia vera

Primary erythrocytosis

Functional erythropoietin-secreting renal neoplasm

Mild dehydration/hemoconcentration

Mild dehydration/hemoconcentration

Why is splenic contraction less likely to be the cause of  the changes presented in Question 8?

Total protein should be unchanged with splenic contraction

Horses do not demonstrate splenic contraction with stress

Splenic contraction is only seen in ruminants

Only total protein elevation is noted with splenic contraction

Total protein should be unchanged with splenic contraction

What is the most correct interpretation of the blood smear (image copied here from Question 10 for ease of viewing)?

There is rouleaux formation of the RBC which is concerning for immune-mediated disease

There is RBC agglutination which is considered normal in the horse

There is RBC agglutination which is concerning for immune-mediated disease

There is rouleaux formation of the RBC which is considered normal in the horse

There is rouleaux formation of the RBC which is considered normal in the horse

You are presented with a 5-year-old MC Maltipoo that has been a little quiet over the last week or so.  He is still eating but wants to play less than usual.  On PE you notice that his sclerae have a yellow tinge and his oral mucous membranes are a little pale compared to what you are used to.  Your chemistry analyzer is broken, but your in-house CBC results are below, as well as a blood smear. Use this information for questions 11-14.

	Result	Ref Range
RBC	3.1 M/uL	6.54-12.20
HCT	14 %	30.3-52.3
HGB	6.1 g/dL	9.8-16.2
MCV	62.1 fL	35.9-53.1
MCH	11.5 pg	11.8-17.3
MCHC	25.1 g/dL	28.1-35.8
%Retic	10 %
Retic	480 K/uL	3.0-50.0

How would you describe the erythrogram?

Severe, regenerative, microcytic, hyperchromic anemia

Severe, regenerative, macrocytic, hypochromic anemia

Severe, non-regenerative, microcytic, hyperchromic anemia

Severe, non-regenerative, macrocytic, hypochromic anemia

Severe, regenerative, macrocytic, hypochromic anemia

What is the most likely mechanism of the decreased MCHC in the data presented in Question 11?

Increased platelets cause analytic error

Immature RBC are smaller and have more hemoglobin than mature RBC

Increased band neutrophils cause analytic error

Immature RBC are larger and have less hemoglobin than mature RBC

Immature RBC are larger and have less hemoglobin than mature RBC

What RBC morphology is displayed in this cell which is seen in the smear in Question 11?

Nucleated RBC

Spherocyte

Echinocyte

Heinz body

Spherocyte

What is the most likely diagnosis for the Maltipoo presented in Question 11?

Iron deficiency anemia

Chronic renal disease

Immune-mediated hemolytic anemia

Snake envenomation

Immune-mediated hemolytic anemia

You are doing relief work at a clinic in Florida and you are presented a beagle for evaluation of severe swelling of the muzzle which is very painful.  You have some suspicions and ask your techs to make a blood smear, which is seen below.  

Which abnormality is seen?

Howell-Jolly bodies

Echinocyte

Schistocytes

Poikilocytes

Echinocyte

Based on the history and blood smear presented in Question 15, what is the most likely diagnosis?

Trauma

Tooth root abscess

Snake envenomation

Vascular neoplasm

Snake envenomation

Snake-cat is a 3-year-old FS ferret.  The owners bring her to you because they have noticed that for the past week or so, she is eating less, less playful, and has dark, almost black stools.  On physical exam, Snake-cat’s oral mucous membranes are pale, and she is painful on palpation of her cranial abdomen.  Your amazing technician gets a blood sample, but only enough for a PCV/TP and a smear. 

Parameter	Patient	Reference range
PCV	28	45-55%
TP	3.1	4.8-6.8 g/dL
Microscopic findings	Moderate anisocytosis, marked polychromasia

How would you characterize the blood findings?

        Moderate anemia but unable to comment on regeneration

        Moderate anemia that appears regenerative with hypoproteinemia

        Moderate anemia that appears non-regenerative with hypoproteinemia

   Moderate anemia that appears regenerative with hypoproteinemia

You remember a couple of things about ferrets, including that they are prone to stomach ulcers associated with a bacteria called Helicobacter, but they are also prone to chronic renal disease.  Do the history and erythrogram support either of these diagnoses?

Yes, they support anemia associated with renal disease

Yes, they support blood loss from GI ulceration

No, neither of these diagnoses would be supported by this data

Yes, they support blood loss from GI ulceration

Snake-cat is hospitalized and an IV catheter is placed to start fluid therapy.  The next day, Snake-cat seems brighter.  You draw another sample and the results are presented below.

 

Parameter	Patient (presentation)	Patient (after 24 hours of IV fluids)	Reference range
PCV	28	24	45-55%
TP	3.1	2.8	4.8-6.8 g/dL
Microscopic findings	Moderate anisocytosis, marked polychromasia	Moderate anisocytosis, marked polychromasia

 

What is the most likely interpretation of these results?

There is progression of renal disease 

The values have decreased because of rehydration with IV fluids

The values have decreased because the fluid rate is insufficient and Snake-Cat is more dehydrated than at presentation

The values have decreased because of splenic contraction

The values have decreased because of rehydration with IV fluids

Although not evident in the current smears, which deficiency should be considered in patients with chronic GI bleeds that may decrease regenerative abilities?

Copper

Selenium

Methemoglobin

Iron

Iron

Reasoning: with chronic blood loss iron stores deplete over time; Iron is the most classic and relevant concern out of the options