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Anemia - Coggle Diagram
Anemia
types
regenerative types
blood loss
causes
coagulopathies
neoplasia
surgery
parasitism
trauma
both RBCs and protein are lost
internal? protein may be reabsorbed
HCT and plasma protein will not decrease until plasma volume is replaced!
acute hemorrhage expectations
no change in erythrogram until fluid shifts restore intravascular fluid volume
24-72h, fluid shifts restore
measurable decrease in RBC mass and protein
normocytic
normochromic
non-regenerative
5-7d
regenerative
macrocytic
hypochromic
destruction
types
intravascular
destroyed in circulation
acute kidney injury possible
extravascular
destroyed by macrophages
occuring in spleen
immune-mediated hemolytic anemia
anti-erythrocyte Ab binding
primary
idiopathic
secondary
neoplasia
drugs
infectious agents
neonatal isoerythroclysis
characteristics
often regenerative, occasionally not (PIMA)
can be either intravascular or extravascular
pathophysiologial mechanism
decreased RBC life due to incresaed RBC destruction
non-regenerative type
lack of bone marrow response
morphology
normochromic
normocytic
anemia of renal failure
morderate to severe
morphology
normochromic
normocytic
decreased Epo production
pure red cell aplasia (PRCA)
severe anemia
morphology
normochromic
normocytic
+/- spherocytes
Coomb's +
Heinz body (oxidative) anemias
endogenous oxidants
mild anemia
no evidence of RBC lysis
minor RBc morph change
:cat:
exogenous
magnitude can vary
morph changes can vary
all species
usually toxin-induced
fragmentation anemias
parasitism
erythrocyte enzyme deficiencies
Fe deficiencies
causes
chronic GI blood loss
large parasite burden
coagulopathies
neonate
initially regenerative
progresses to poorly regenerative to non-regenerative
morphology
variable regeneration
impaired Hgb synthesis = extra cell divisions
microcytic
hypochromic
shape changes
keratocytes
schisocytes
thrombocytosis
reticulocytes
aggregate reticulocytes
most recently released from bone marrow
puncuated reticulocytes
maturing over 1-2w
counts
reported as # cells/ul
do not use percentages
gold standard for regeneration
not useful for horses or ruminants
what is useful?
serial PCV/HCT
horses
bone marrow evaluation
increased MCV
ruminants
blood film evaluation
polychromasia
basophilic stippling
they don't release reticulocytes
reference interval
above RI
regenerative
within
or below
non-regenerative
polychromasia
subjective
estimation best when absolute reitculocyte count was elevated
not accurate
classification
severity
RBC indices (MCV/MCHC)
normocytic
macrocytic
microcytic
normochromic
hypochromic
bone marrow response
regenerative
non-regerative
in response to anemia, RBC production should increase
defined by immature RBCs (reticulocytes) in circulation
increase in 2-3d and peak 7-10d post-stimulus
be patient
phases of determining mechanism
phase 1
diagnostics
CBC
retic count
plasma protein
classification
blood loss?
hemolysis?
phase 2
diagnostics
Coomb's
Fe panel
chem
classification
CRF?
Fe deficiency?
hemolysis?
GI loss?
phase 3
diagnostics
bone marrow evaluation
classification
production defects
bone marrow dz?
characteristics
decrease in 1 or more measures of red cell mass
PCV
[Hgb]
RBC count
HCT
not a dz, seek underlying cause
loss of RBCs
hemorrhage
destruction of RBCs
hemolysis
failure of production
erythrocytosis
relative
loss of plasma volume
redistribution of RBCs
causes
dehydration
increase TPP supports
splenic contraction
cats
horses
TPP will be normal
transient
absolute
true increase in RBC mass
primary
rare
neoplasm
RBC production independent of Epo
clinical signs
increaesd blood viscosity
cyanosis
poor perfusion
secondary
RBC production dependent on Epo
secondary hypoxia
