SA Med F, Anemia/RBCtosis

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  1. Do puppies/kittens have PCVs lower or higher than adults?
    pups usually have lower (hi20s/lo30s)
  2. what are 2 breeds with higher than average PCV?
    • sight hounds
    • dachshunds
  3. what species demonstrates pica as clinical sign for anemia?
  4. why is heart murmur associated with anemia?
    • incr. sympathetic tone - ejection murmur
    • (not viscosity issue)
  5. What type of anemia is seen with FeLV?
    non regenerative macrocytic anemia
  6. If PCV is markedly low but pt not exhibiting clinical signs, what does this indicate?
    chronicity - patient adapted to decr. O2
  7. will IMHA or GI/iron deficiency bleeds caused mild or severe anemia?
  8. Bloodwork results show mild/mod anemia and smear has spherocytes. What is at top of your differential?
  9. What are characteristics of regeneration?
    • incr. MCV/MCHC/RDW
    • polychromasia, anisocytosis, spheroctyes
    • reticulocytosis
    • NRBCs (metarubricytes)
  10. what is reticulocyte index?
    • patient PVC divided by 45 x retic % = RI
    • > 2.5 = regenerative
  11. What absolute reticulocyte number indicates regeneration?
  12. what are two major causes of regenerative anemia?
    • hemorrhage (seen after 48-96hr)
    • hemolysis
  13. What congenital cause of hemolysis is Westie associated with ?
    pyruvate kinase deficiency
  14. what congenital cause of hemolysis is English Springer Spaniel associated with?
    phosphofructokinase deficiency
  15. what are 4 causes of acquired hemolysis?
    • IMHA (most common)
    • hemangiosarcoma - microangiopathic
    • infections (babesia, ehrlichiosis, etc)
    • hypoP (as w/DKA patient)
  16. what drugs are known to cause IMHA?
    • sulfas, anticonvulsants
    • penicillins, cephalosporins
    • methimazole
    • zinc (pennies after 1983)
  17. What type of immune reaction is IMHA?
    type II hypersensitivity (cytotoxic)
  18. Are most IMHA's primary or secondary?
    most primary (but only know this after r/o secondary)
  19. The most common form of IMHA in dog is class III. what immunoglobulin is mediator? intra or extravascular hemolysis?
    • IgG mediated
    • extravascular
    • spherocytes
  20. which class of IMHA is mediated by IgM, complement is involved and causes INTRA vascular hemolysis?
    class II
  21. what are the "cold" classes of IMHA?
    • 4: cold agglutination - intravascular
    • 5: cold induces extravascular
  22. what are 3 causes of primary IMHA?
    • idiopathic
    • SLE
    • unidentified infection
  23. when cats get IMHA is it usually primary or secondary?
    secondary to drugs like methimazole, neoplasia, vaccines, toxins, infections
  24. what signalment and breeds are associated w/IMHA?
    • any age/breed but more females, middle aged
    • American/English Cocker,
    • OESD, GSD,
    • irish setter, standard poodle
  25. when does IMHA patient present with petechia/ecchymoses?
    w/ concurrent ITP (Evan's syndrome)
  26. what is leukemoid reaction?
    profound left shift neutrophilia (not from infection/inflammation) because bone marrow releases all lines of immature cells
  27. Why would liver enzymes be elevated with IMHA?
    hypoxia in liver - hepatic injury
  28. If slide agglutination test is negative, what is a further test you could run?
    Coomb's Test (looks for Antibodies on RBCs - agglutination)
  29. Why is bilirubin elevated w/IMHA? Elevations greater than what # are poor prognostic indicator?
    • prehepatic - hemolysis
    • >10 mg/dL
  30. If anemia is nonregenerative, bone marrow can be assessed. What does RBC aplasia mean? what does RBC hyperplasia mean?
    • aplasia: maturation arrest; only immatures put in circulation
    • hyperplasia indicates regeneration
  31. what is antinuclear antibody test looking for?
    IgG binding to nuclear components of RBCs
  32. how is IMHA treated?
    • immunosuppresion: initially Dexamethasone (more potent than pred - pred ok once eating)
    • 2mg/kg/day
  33. After initiating therapy, when do you expect to see improvement? how long is therapy continued?
    • improve markedly in 24-96 hours (1/3 won't respond)
    • long term 3-6 mos; slow taper off
  34. what are additional drugs reserved for refractory cases?
    • cyclosporine
    • azathioprine
    • leflunomide
    • (splenectomy if all else failed)
  35. in addition to immunosuppression, what other medication should you start while some diagnostics are pending?
    doxycycline (tick born dz) or azithromycin
  36. what meds are options to prevent thromboembolism?
    • low dose aspirin
    • low molecular wt or fractioned heparin
    • clopidogrel
  37. what is most common cause of nonregenerative anemia in dog/cat?
    • anemia of chronic disease
    • (mild, no clinical signs; normocytic/normochromic)
  38. what are other causes of nonregenerative anemia?
    • bone marrow disorder
    • anemia of renal disease
    • acute blood loss (first 24-96hr)
  39. what is the most common cause of semi-regenerative anemia?
    iron deficiency (microcytic) from GI blood loss
  40. what does semi-regenerative anemia look like on CBC?
    • lots of platelets
    • high RDW
    • mild reticulocytosis
  41. which tumors are associated w/semiregenerative anemia?
    • leiomyomas/-sarcomas
    • LSA
    • carcinoma
  42. what is most common cause of polycythemia?
    relative - hemoconcentration/dehydration (elevated TP)
  43. what is TP with absolute polycythemia?
    normal TP
  44. why is arterial blood gas run in patient with absolute polycythemia?
    • look for cardiopulmonary disease as cause
    • PaO2 <60
    • pulse ox <80%
  45. what other diagnostics are run with absolute polycythemia?
    • imaging to look for neoplasia
    • (excess EPO as paraneoplastic condition or due to renal disease/hypoxia)
  46. Although it is difficult to find labs that run EPO levels, what does it mean if CBC shows absolute polycythemia and EPO level is low?
    • primary polycythemia (polycythemia rubra vera)
    • tx w/hydroxyurea and phlebotomy
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SA Med F, Anemia/RBCtosis
SA Med F, Anemia/RBCtosis
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