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Anaemia (decreased PCV, HCT, Hb, RBC) - Coggle Diagram

- - - - decreased
        
        haemorrhage
        
        increased/normal
        
        Haemolysis
        
        Non-regenerative anaemia
- - - - Primary (idiopathic)
      - small proportion are non-regenerative due to destruction of RBC precursors in bone marrow
      - Secondary
        
        Neoplasia
        
        esp. lymphoma
        
        Drugs
        
        sulphonamides
        
        penicillin
        
        methimazole
      - Hyperbilirubinaemia
      - Spherocytosis (blood smear)
        
        common in IMHA, but can also occur for other reasons
        
        small numbers can be hereditary (rare)
        
        monocular phagocytic neoplasm
        
        microangiopathic haemolysis
        
        zinc toxicity
        
        hypophosphataemia
      - Inflammatory leukogram
      - Thrombocytopenia
      - Autoagglutination (blood smear)
        
        distinguish from Rouleaux formation
      - Direct Coombs test with polyvalent antisera
      - Reduced MCH, MCHC
      - In saline agglutination test
        
        performed by adding a drop of saline (2 drops in cats) to a drop of EDTA blood on a glass slide and assess for macroscopic and microscopic agglutination
    - - Babesiosis
        
        this can mimic idiopathic IMHA
      - Ehrlichiosis
      - Mycoplasma haemofelis in cats
        
        if +ve for M.haemofelis but does not have a regenerative anaemia, other underlying disease should be sought
        
        older male non-pedigree cats seem to be at greater risk, but younger cats more likely to show signs of disease
        
        asymptomatic carrier cats possible
      - Polymerase Chain Reaction (PCR)
    - - zinc
      - paracetamol
      - onions
    - - does not cause a change in circulating blood volume
    - - Macrophages in liver, spleen etc
      - Mainly IgG mediated
      - Increase serum bilirubin (jaundice)
    - - RBC lysis in circulation -> HB release
      - IgM
      - Red plasma in centrifuged sample
    - - pyruvate kinase (PK) deficiency
        
        Basenjis
        
        West highland white terriers
      - phosphofructinase (PFK) deficiency
        
        english springer spaniels
        
        suffer acute exercise-induced episodes of haemolysis
      - usually affected dogs have clinical signs from a relatively young age
    - - hypophosphataemia
  - - - Trauma
        
        RTA
        
        Arterial bleed
      - Thorax
      - Spleen
      - amyloidosis
      - Suspect if...
        
        any case of unexplained anaemia
        
        melaena or haematemesis
        
        (GIT bleeding)
        
        treat with gastroprotectants such as omeprazole and sucralfate
        
        fluid thrill on abdominal percussion (haemoabdomen)
        
        tachypnoea with ventral dullness on thoracic auscultation and percussion (haemothorax)
        
        tachypnoea with crackles
        
        pulmonary contusions
        
        Cautious fluid therapy, very easy to cause worsening of pulmonary haemorrhage and irreversible respiratory failure
      - In no obvious source of haemorrhage...
        
        abdominocentesis
        
        thoracic/abdominal ultrasonography
        
        radiography
        
        an in house blood smear should be examined to assess adequacy of platelet numbers
        
        10-15 per high power field
        
        (in house haematology analysers can sometimes provide inaccurate assessments of platelet numbers)
        
        also can assess for evidence of regeneration
        
        anisocytosis
        
        polychromasia
        
        spherocytosis
    - - Gastrointestinal ulceration
      - Epistaxis
      - Severe ectoparasite (rarely endoparasite) burden
      - Bleeding tumour
        
        e.g. splenic haemangiosarcoma
        
        hypoproteinaemia
      - Urinary tract
      - If chronic will eventually cause Fe deficit
    - - Warfarin toxicity
        
        vitamin K treatment
      - Von Willebrand's disease
      - Thrombocytopenia
      - Disseminated intravascular coagulation
      - Useful tests
        
        platelet counts
        
        buccal mucosal bleeding time
        
        if platelets are adequate
        
        assays of clotting times
        
        prothrombin time (PT)
        
        activated partial thromboplastin time (APTT)
    - - Severe haemorrhage will cause sign son hypovolaemic shock, initially with bounding pulse, progressing to a weak, thready pulse as compensation fails
    - - Maybe check
        
        Coagulation profile
        
        Platelet count
        
        Faecal lungworm
        
        ACTH stim test
    - - treat or remove the underlying cause
      - Transfusion therapy
        
        Fresh whole blood
      - clinical signs of hypovolaemia due to acute haemorrhage
        
        IV crystalloids +/- colloids, with attempts to control haemorrhage
      - pressure bandages applied to areas of external haemorrhage
      - Abdominal bandage can be placed on patients with abdominal bleeding, whilst patient stabilised prior to surgery
    - - urinalysis
      - faecal occult blood testing
        
        following 3d of a meat free diet
      - survey imaging
  - - - increased mean corpuscular volume (MCV)
    - - polychromasia
      - anisocytosis
    - - but can occur with lead toxicity and splenic pathology
- - - - May induce IMHA or 1RY bone marrow disease
      - always test for this in anaemic cats
      - Macro/normocytic, normochromic
    - - Pure red cell aplasia
        
        Marked depletion or absence of erythroid precursors in bone marrow
        
        differentiate from IMHA (may be spherocytes and +ve coombs test)
      - Aplastic anaemia
        
        Depletion of all haematopoietic cells in bone marrow
      - Myelodysplasia
        
        abnormal maturation/production of cells in bone marrow
      - Myelofibrosis
        
        Normal haematopoietic tissue replaced with fibrous tissue
      - Myelophthisis (neoplasia)
      - If severe and no cause identified on screening test
      - Bi-/pancytopaenia
        
        thrombocytopenia
        
        neutropenia
      - Lymphopenia common and often seen as part of stress leukogram
      - Bone marrow sampling
        
        sedation/GA
        
        iliac crest/humerus
        
        aspirate and smear quickly as clots in seconds-minutes
  - - - dog (25-36%)
      - cat (18-26%)
  - - - Thrombocytosis
        
        if due to haemorrhage
      - In cats or early in dogs
        
        Normocytic
        
        Normochromic
      - Poikilocytosis
        
        (abnormally shaped RBC e.g. flatter)
      - Hypochromasia
        
        low MCHC
      - Microcytosis
        
        low MCV
  - - - inadequate EPO production
      - decreased erythrocyte lifespan
      - decreased marrow response to EPO
      - Haemorrhage caused by uraemic ulcers
  - - - pancytopenia possible
- - - - microangiopathic haemolytic anaemia
      - disseminated intravascular coagulation
      - haemangiosarcoma
      - glomerulonephritis
      - myelofibrosis
      - haemolytic uremic syndrome
      - Hypersplenism
    - - congestive heart failure
      - valvular stenosis
      - caval syndrome in heart worm disease
      - haemangiosarcoma
    - - chronic doxorubicin toxicosis
      - severe iron deficiency anaemia
      - pyruvate kinase deficiency
      - congenital and acquired dyserythropoiesis
  - - - haemangiosarcoma
      - glomerulonephritis
      - lymphoma
      - hepatic disease
  - - - always small numbers in healthy cats
        
        (almost always indicative of pathology in dogs)
      - toxins that cause oxidative injury
        
        onion
        
        garlic
        
        paracetamol
        
        excessive vitamin k3
        
        benzocaine-containing local anaesthetics
        
        zinc
        
        toilet bowl cleanser
      - Splenectomised animals, after corticosteroid therapy and patients with severe splenic dysfunction