Clin Path-Anemia.txt

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Mawad
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284423
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Clin Path-Anemia.txt
Updated:
2014-09-29 21:00:05
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vet med
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anemia
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  1. Anemia is defined as a _________ and occurs when...
    decrease in RBC mass; there is an imbalance between RBC production and RBC loss or destruction, resulting in decreased O2 delivery to the tissues
  2. The easiest way to measure anemia is...
    PCV
  3. When PCV AND TP are decreased, the mechanism of anemia is _____.
    external hemorrhage
  4. When PCV is decreased and TP is normal, the mechanism of anemia is _____ (3).
    internal hemorrhage, hemolysis, decrease in RBC production
  5. hen PCV AND TP are increased, the mechanism is _____.
    hemoconcentration (dehydration)
  6. When PCV is normal and TP is increased, the mechanism is _____(2).
    anemia + dehydration; increased protein production (hypergammaglobulinemia)
  7. when PCV is increased and TP is normal, the mechanism is ______ (3).
    splenic contraction, dehydration+hypoproteinnemia, polycythemia
  8. When PCV is normal and TP is decreased, the mechanism is ______ (2).
    decreased protein production, increased protein loss.
  9. What does gradual onset of listlessness indicate? (4)
    chronic blood loss, chronic kidney disease, anemia of chronic disease, or BM suppression
  10. What does the acute onset of listlessness indicate?
    acute hemorrhage or hemolysis
  11. What does a history of periodic episodes of weakness indicate?
    intra-abdominal vascular tumors that bleed periodically then seal and reabsorb
  12. What do polyuria and polydipsia indicate? (2)
    chronic kidney disease or decreased EPO production
  13. What does a history of external blood loss indicate? (3)
    trauma, decreased platelets, or ulcerated tumors
  14. What does a history of weight loss, fever, and general malaise indicate?
    anemia of chronic disease
  15. List clinical findings associated with anemia (14)
    weakness, lethargy, exercise intolerance, hyperpnea, exertional dyspnea, tachycardia, functional systolic murmur, pale mucous membranes, fever, hemoglobinemia, hemoglobinuria, icterus, blood in urine or feces, pica (in some animals, cats)
  16. Increased respiratory rate.
    hyperpnea
  17. Difficulty breathing during exercise.
    Exertional dyspnea
  18. Increased heart rate.
    tachycardia
  19. Why would an animal develop a functional systolic murmur due to anemia?
    low blood viscosity
  20. Free Hb in the blood.
    Hemoglobinemia
  21. Free Hb in the urine.
    Hemoglobinuria
  22. What are physiologic mechanisms for animals to adapt to anemia? (9)
    decreased activity, increased respiratory rate and heart rate, splenic contraction, mobilization of RBC reserves, increased water intake, renal fluid conservation,selective vasoconstriction to increase blood flow to the brain and heart, increased 2,3-DPG production (facilitate easier release of O2 in the tissues), increased erythropoiesis (regenerative anemia)
  23. How does increase production of 2,3-DPG help an animal adapt to anemia?
    2,3-DPG lowers the affinity of O2 for heme, so the O2 is more readily released to the tissues when there is more 2,3-DPG
  24. When you determine that an animal is anemic, the next step is...
    to determine whether it is regenerative or non-regenerative based on the reticulocyte count
  25. Regenerative anemia usually occurs with _______(2).
    hemorrhage or hemolysis
  26. Non-regenerative anemia occurs with ____________. (3)
    chronic disease, chronic kidney disease, or primary BM disease
  27. How do you determine the type of anemia in a cat?
    only aggregate reticulocytes are counted; reticulocyte count
  28. How do you determine the type of anemia in a dog?
    reticulocyte count
  29. How do you determine the type of anemia in a cow?
    Basophilic stippling
  30. How do you determine the type of anemia in a horse?
    increased MCV of > or = 2fl or an increased RDW; macrocytic and normochromic
  31. Hemolysis usually stimulates a _____ reticulocyte response than hemorrhage.
    greater
  32. What are causes of transient physiologic reticulocytosis in nonanemic animals?
    excitement, exercise, certain drugs (due to splenic contraction)
  33. Describe the RBC indices of regenerative anemia.
    macrocytic ( increased MCV) and hypochromic (decrease MCHC)
  34. Describe the RBC indices of non-regenerative anemia.
    normocytic, normochromic
  35. Describe the RBC indices of iron deficiency.
    microcytic (decreased MCV), hypochromic (decreased MCHC)
  36. What are the characteristics of anemia due to pathogenesis? (3)
    blood loss, hemolysis, decreased proliferation of hematopoietic precursors
  37. What would you see on a blood smear of an animal with regenerative anemia? (7)
    macrocytic, hypochromic RBCs, polychromasia, anisocytosis, Howell-Jolly bodies, nRBCs, and in cattle, basophilic stippling
  38. Historical or physical evidence of hemorrhage include... (4)
    melena (blood in stool), hematuria (blood in urine), epistaxis (blood from nasal cavity), blood in body cavities
  39. Historical or physical evidence of hemolysis include...(4)
    icterus, bright yellow urine, splenomegaly, and no evidence of blood loss
  40. Anemia of chronic disease (ACD) can be associated with an ______.
    inflammatory leukogram
  41. Chronic kidney disease is asociated with ________. (3)
    decreased EPO, azotemia, and low urine specific gravity
  42. Regenerative anemia usually has:
    MCV-
    MCHC-
    And the examination of the blood film may reveal... (5)
    Macrocytic, hypochromic; polychromasia, Howell-Jolly bodies, anisocytosis, nRBCs, and in some species (cows) bassophilic stippling
  43. Causes of hemorrhage include... (3)
    trauma, surgery, or hemorrhagic lesions
  44. What will you see on a blood film of an animal with splenic hemangiosarcoma (tumor associated ith internal hemorrhage)?
    nRBCs, RBC fragments, and acanthocytes
  45. What are additional diagnostic tests to consider for cases of suspected hemorrhage? (7)
    fecal examination for internal parasites, occult blood (test for blood in stool), urinalysis to detect hematuria, platelet count and coagulation panel, serum biochemical profile, thoracic and abdominal radiography for effusions or masses, contrast studies of the GI tract and urinary system
  46. What is the most common cause of iron deficiency anemia (IDA)?
    chronic external blood loss
  47. An animal with IDA (iron deficiency anemia) will show the following RBC indices:
    MCV-
    MCHC-
    TP-
    The blood film may show the following characteristics...(7)
    • MCV- microcytic
    • MCHC- hypochromic
    • TP- decreased in 1/3 of cases
    • Anisoytosis, blister cells, apple stem cells, keratocytes, fragmentation, and target cells, thrombocytosis
  48. Why are RBCs usually microcytic with IDA?
    Erythroid cells undergo extra divisions when Fe is unavailable
  49. Serum iron (SI) measures ________; SI is ________ with IDA.
    iron bound to transferrin; decreased
  50. Total iron binding capacity (TIBC) is an indirect measurement of _______; TIBC is __________ with IDA.
    transferrin; normal or increased
  51. % transferring saturation is calculated by the equation ___________; it is ______ with IDA.
    SI/TIBC x 100; decreased
  52. Serum ferritin concentration is a measure of _________; it is ______ with IDA and _______ with inflammation.
    Fe stores in macrophages; decreased; increased
  53. Why does hemolytic anemia have a more markedly regenerative response than blood loss anemia?
    iron and protein are readily available for erythropoiesis
  54. _________ hemolysis occurs more commonly than _______ hemolysis.
    extravascular; intravascular
  55. Extravascular hemolysis refers to ______________________.
    RBC phagocytosis by macrophages in the liver, spleen, and lymph nodes
  56. Why is bilirubinemia/uria commonly present with extravascular hemolysis?
    macrophages metabolize heme to bilirubin.
  57. Intravascular hemolysis refers to ______________.
    RBC lysis within blood vessels due to Ab and complement binding
  58. Increased MCHC is almost always indicative of __________.
    intravascular hemolysis
  59. With intravascular hemolysis, heme is metabolized to _________, causing _______.
    bilirubin; bilirubinemia
  60. Hemoglobinemia/uria occur with _______ hemolysis, but NOT with _______ hemolysis.
    intravascular; extravascular
  61. _________ is the most common cause of hemolytic anemia in dogs.
    immune-mediated hemolytic anemia (IMHA)
  62. Clinical signs of IMHA include... (10)
    weakness, pallor, dyspnea, tachycardia, heart murmur, fever, bilirubinemia, hemoglobinemia/uria, splenomegaly, peteciae (is there is also immune-mediated thrombocytopenia)
  63. Immune-mediated hemolytic anemia has the following laboratory findings:
    MCV-
    MCHC-
    TP-
    Reticulocytes-
    And the following RBC findings on the blood film... (5)
    And the following WBC findings on the blood smear/CBC...
    • MCV- macrocytic
    • MCHC- hypochromic
    • TP- normal to increased
    • Reticulocytes- increased
    • Polychromasia, anisocytosis, Howell-Jolly bodies, sphereocytes (almost ALWAYS), and SOMETIMES agglutination
    • Leukocytosis, monocytosis, left shift (immature granulocytes, neutrophils)
  64. Test that detects antibodies or complement on the patient's RBCs.
    Direct Coombs' Test
  65. With a Direct Coombs' Test, the RBCs agglutinate if...
    the patient's RBCs are coated with antibody or complement (positive result)
  66. What classification of IMHA is most common?
    primary (idiopathic)
  67. The most common antibodies inIMHA in dogs are ___________, usually causing ________ hemolysis.
    warm-reacting Ab (IgG); extravascular
  68. What are the basic treatments for IMHA?
    Treat underlying cause, supportive care (decrease activity, increase oxygen), and provide immunosuppressive therapy
  69. In what cases of IMHA is the anemia non-regenerative?
    if the onset is peracute (not enough time for regenerative response)
  70. How is the pentose-phosphate pathway involved with heinz-body hemolytic anemia?
    deficiencies in the enzymes of this pathway result in increased oxidative damage
  71. How is the embden-meyerhof pathway involved with heinz-body hemolytic anemia?
    deficiency in the enzyme NADH-methemoglobin reductase; Fe3+ can't bind oxygen
  72. Oxidative compounds may react with ______ of Hb, causing denaturation and formation of ________.
    sulfhydryl groups; heinz bodies
  73. Presence of _____ and ______ occur in heinz-body hemolytic anemia.
    heinz bodies and eccentrocytes
  74. Heinz body hemolytic anemia occurs with exposure to... (2)
    plants (onions, leeks, garlic, wilted red maple leaves in horses, brassica), drugs and chemicals (acetaminophen, Cu toxicity, zinc toxicity)
  75. Infectious diseases that cause regenerative anemia include.... (4)
    Hemotropic parasites, Leptospirosis, Colostridium haemolyticum (bacillary hemoglobinuria), Colostridium perfringens
  76. Infectious disease characterized by cold agglutinins, intravascular and extravascular hemolysis, hemoglobineamia/uria, and regenerative anemia; organisms are shed in urine.
    Leptospirosis
  77. Infectious disease characterized by intravascular hemolysis, icterus, hemoglobinemia/uria, regenerative anemia, and reddish nasal discharge; gram + rod found in alkaline soil.
    Colostridium haemolyticum (bacillary hamoglobinuria)
  78. Infectious disease characterized by intravascular hemolytic anemia, immune-mediated hemolytic anemia, regenerative response, and reticulocytosis (even in horses!!!).
    Clostridium perfringens
  79. Disease characterized by the formation of fragmented RBCs because of obstructions in the vessels, DIC, regenerative anemia; often seen with hemangiosarcoma.
    Microangiopathic disease
  80. Water intoxication causes _____________ hemolysis.
    intravascular, regenerative
  81. Hypophosphatemia is characterized by ______________ hemolysis.
    intravascular, regenerative
  82. Hereditary sphereocytosis is characterized by... (3)
    sphereocytes, hemolytic anemia, and splenomegaly
  83. PFK deficiency is associated with... (3)
    decreased ATP production, shortened RBC lifespan, decreased 2,3-DPG
  84. PFK deficiency is characterized by... (4)
    intravascular hemolysis, barking, stress, and marked reticulocytosis
  85. PK deficiency is associated with...(3)
    decreased RBC life span, hemolytic anemia, increased 2,3-DPG
  86. PK deficiency is characterized by...(3)
    macrocytic, hypochromic anemia with marked reticulocytosis
  87. Acquired porphyria can occur with... (3)
    lead toxicity (most common), iron deficiency, chronic inflammatory disease
  88. Non-regenerative anemia can be due to... (2)
    primary or secondary BM suppression (most commonly secondary)
  89. Most common reason for non-regenerative anemia due to secondary BM suppression?
    Anemia of chronic disease.
  90. Laboratory changes associated with anemia of chronic disease: MCV=, MCHC=,SI=, TIBC=, transferrin saturation=, iron storage=, serum ferritin=
    normocytic, normochromic, SI= low, TIBC= normal to decreased, transferrin saturation= decreased, iron storage=increased, serum ferrition= normal to increased
  91. Anemia of chronic disease is associated with an _____________.
    inflammatory leukogram (leukocytosis, left shift, monocytosis)
  92. The pathophysiology of anemia of chronic disease involves... (4)
    decreased EPO production, decreased BM response to EPO, increased Fe storage in macrophages, shortened RBC lifespan
  93. Anemia associated with chronic kidney disease is primary caused by....
    decreased EPO production, wit or without decreased BM response to EPO
  94. Laboratory findings associated with anemia due to chronic kidney diseased include:
    MCV-
    MCHC-
    Urine Specific Gravity-
    normocytic, normochromic, decreased
  95. How is anemia due to chronic kidney disease treated?
    improving or preventing progression of renal function
  96. Hypothyroidism causes anemia that is ______(MCV) and ______(MCHC) due to... (2)
    normocytic; normochromic; low metabolic rate and low EPO
  97. Hypoadrenocorticoidism causes mild _______(MCV) and _______(MCHC) anemia due to... (2)
    normocytic; normochromic; decreased EPO production and diminished action of adrenocorticoid hormones on HSCs
  98. Aplastic anemia is a cause of ___________
    non-regenerative anemia due to a primary BM suppression
  99. Aplastic anemia refers to _______.
    decreased hematopoiesis
  100. Pure red cell aplasia (PRCA) is characterized by... (3)
    marked erythroid hypoplasia or aplasia, normal granulopoiesis, and normal thrombopoiesis
  101. Pure red cell aplasia (PRCA) in dogs is usually due to...
    antibodies directed against erythroid precursors
  102. Pure red cell aplasia (PRCA) in dogs shows the following two characteristics on a blood film...
    sphereocytes and agglutination (because it is usually due to an immune-mediated mechanism)
  103. Pure red cell aplasia (PRCA) in dogs is usually treated with ________.
    immunosuppressive drugs (because it is commonly caused by an immune-mediated mechanism)
  104. Myelophthisis is a primary BM suppressive disease characterized by...
    replacement of BM with neoplastic or inflammatory cells
  105. Estrogen toxicity occurs in _________ and causes...(2) followed by... (3)
    dogs and ferrets; transient neutrophilic leukocytosis and thrombocytosis; BM suppression with leukopenia, thrmbocytopenia, and nonregenerative anemia.
  106. Bracken fern poisoning in cattle results in... (1)
    tumors of the bladder
  107. FeLV results in the following laboratory findings:
    MVC-
    MCHC-
    normocytic or macrocyctic; normochromic
  108. With FeLV infection, hemolysis may occurs from... (4)
    immune-mediated mechanisms, heinz body formation, mycoplasma infection, or chronic inflammatory disease
  109. Equine infectious anemia is caused by a ______ , transmitted by...
    retrovirus; biting insects, blood contaminated equipment, transfusion, and transplacentally
  110. The equine infectious anemia (EIA) antigen replicates in _________ and results in _________ infection.
    host macrophages; lifelong
  111. Laboratory findings associated with equine infectious anemia include:
    MCV-
    MCHC-
    WBC abnormalities-
    Serum albumin-
    Globulin-
    normocytic, normochromic, thrombocytopenia, decreased serum albumin, increased globulins
  112. What test is used to detect antibodies to equine infectious anemia?
    Coggins test
  113. What nutritional deficiency results in normocytic non-regenerative anemia?
    protein deficiency

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