Regenerative Anemia

What is used to dx anemia?

PCV/ HCT

Name some clinical signs of anemia?

Pale MM

Lethargy

Increased CRT

Tachycardia/pnea

Low grade arryrthmias

What are the three general causes of anemia?

Loss (regenerative to non-regenerative w/ time)

Destruction (Regen)

Decreased production (non-regen)

How is regenerative anemia characterized?

Reticulocytosis!!!!

-bonemarrow response

What are analyzer findings of Regenerative anemia?

High MCV - larger RBC

Decreased MCHC - decreased hemoglobin

What are blood smear findings regenerative anemia?

Moderate to marked:

Anisocytosis (Dif sizes)

Polychromasia (purple color change)

Basophilic stippling (in ruminants)

What is macrocytosis?

Increased MCV

What is Hypochromasia?

Decreased MCHC

What will you see in a canine and feline w/ regenerative anemia?

Released polychromatophils

What animal will not release polychromatophils

Horses

Which animal will have Basophilic stippling in regenerative anemia?

Cattle

What are characteristics of polychromatophils?

Larger (increased MCV)

Less hemoglobin (decreased MCHC)

Bluer - more retained proteins

What is Metarubericytosis?

Nucleated RBC - Typically seen as less than 1nRBC/100WBC

Metarubericytosis will NOT equal what?

Regeneration

nRBC and Leukocytes are often confused by the analyzers. What are ways to tell them apart on blood smear?

nRBC have red/purple cytoplasm, pyknotic nuclei, and irregular cell borders

What is appropriate Metarubricytosis?

Increased nRBC in circulation w/ evidence of regeneration (Reticulocyte presence)

Explain how Metarubricytosis occurs?

Bone marrow endothelium contracts to let reticulocytes out and some nRBC can slip out as well

What is a Howell jolly body?

Remains of the nucleus in the RBC

-Can be seen in regenerative anemia but not diagnostic

What is the MOA of Regenerative anemia?

Tissue hypoxia stimulates EPO production leading to reticulocytes being released

How long does it take for bone marrow to respond to anemia?

3-5 days

How do you calculate the absRet?

Reticulocyte % x RBV in the millions

-always need this # to dx regenerative anemia

What can we use to differentiate blood loss and hemolysis regenerative anemia?

Hypoproteneimia is associated with Blood loss

What will we see in Per-acute hemorrhage?

Normocytic/chromatic

Reticulocytes WNL

(Bone marrow hasn't had time to respond)

What will we see in acute hemorrhage?

3-5 days post insult

-Macrocytic (Increased MCV)

-Hypochromic (Decreased MCHC)

-Reticulocytes elevated

What will we see in chronic Hemorrhage?

Several days to weeks

-Depleted iron

-Micorcytic (Decreased MCV)

-Hypochromatic (Decreased MCHC)

-Reticulocytes WNL

Name a few causes of hemolysis?

IMHA

Oxidative damage

Infectious dz

RBC fragmentary inj

What are lab work signs of Extravascular hemolysis?

Hyperbilirubinemia

Bilirubinuria

(Icteric)

What are lab work signs of intravascular hemolysis?

Hemoglobinemia

Hemoglobinuria

(Red urine/ blood)

How does extravascular hemolysis work?

Antibodies mark RBC for splenic macrophage destruction - out of vasculature

How does intravascular hemolysis work?

Toxin/ oxidative damage or MAC complexes causing cell lysis in circulation

What are signs of oxidative intravascular hemolysis?

Heinz bodies

Eccentrocytes

What are signs of complement cascade intravascular hemolysis?

Ghost cells

What will we see in IMHA?

Mostly extravascular hemolysis in dogs (idiopathic)

What are analyzer findings for IMHA?

Macrocytic (Increased MCV)

Hypochromic (Decreased MCHC/ can be falsely normal LIAH)

Reticulocytosis

Inflammatory leukon

What are blood smear findings for IMHA?

Polychromasia

Spherocytes

Ghost cells

What are the following cells?

Spherocytes -only in dogs - smaller w/ no central pallor

How do you tell the difference between Rouleaux and agglutination?

Saline agglutination test

What are possible dx of IMHA?

CBC w/ Blood smear

Saline agglutination

Coombs test

Name a few hemolytic toxins?

Acetominaphen - cats

Red maple leaf - horses

Onion and garlic

Zinc

Copper - small ruminants

What will we see concurrently w/ zinc tox?

Acute hemolytic anemia

Concurrent pancreatitis

What will we see w/ viperine envenomation?

Cytotoxic and coagulopathic effects w/ some intravascular hemolysis

What will we see w/ elapidae envenomation?

Neurotoxic w/ intravascular hemolysis

What are causes of elevated Heinz bodies in cats?

DM

Lymphoma

Hyperthryroidism

Heinz bodies will not cause what?

Hemolytic crisis

Mycoplasma haemofelis will cause what?

Infect the surface of the RBC - Regenerative anemia hemolysis

What will Cytauxzoon felis cause?

Nonregenerative anemia hemolysis

How is Mycoplasma haemofelis spread?

Fleas - most common cause of hemolytic anemia in cats - good prognosis

How is Cytauxzoon felis spread?

Ticks - poor prognosis

What are clinical signs of Cytauxzoon felis ?

Thrombocytopenia

Leukopenia

What breeds are more likely to get Babesia canis?

Greyhounds

What is the following parasite?

Babesia canis

What is the following parasite>

Babesia gibsoni - pitbulls

What is Equine piroplasmosis

Theileria equi

What is the following parasite?

Anaplasma marginale - cattle most common

What is going to cause RBC fragmentation?

DIC

HF

Vasculitis

HW

Neoplasms