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Anemia/Erythrocyte%20Disorders

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Title: Anemia/Erythrocyte%20Disorders


1
Anemia/Erythrocyte Disorders
  • Laboratory Procedures

2
Anemia
  • Defined
  • A condition of reduced oxygen carrying capacity
    of erythrocytes

3
Erythrocyte disorders
  • May be associated with
  • Decreased production of RBCs
  • Increased destruction of RBCs
  • Inappropriate loss of RBCs

4
Diagnosis
  • A systemic, diagnostic approach to anemia is
    necessary and should include
  • Good history
  • Physical exam
  • CBC
  • Blood film/slide analysis

5
Treatment
  • Should be aimed at correcting the primary
    disorder and supporting the patient.
  • IMPORTANT to establish whether the anemia is
    REGENERATIVE or NON-REGENERATIVE.
  • Reticulocyte counts are used to evaluate if the
    anemia is regenerative or non-regenerative.
    WHY???
  • Remember that regenerative anemias are usually
    the result of hemorrhage or hemolysis and
    non-regenerative anemias may involve the bone
    marrow.

6
Treatment Continued
  • Remember that regenerative anemias are usually
    the result of hemorrhage or hemolysis and
    non-regenerative anemias may involve the bone
    marrow.
  • (Remember Myeloproliferative Disorders???)

7
Regenerative v. non-regenerative
  • Regenerative Anemia
  • Increased reticulocytes, nRBCs, anisocytosis,
    polychromasia and Howell-Jolly bodies.
  • Indicates the bone marrow has responded to a
    demand for RBCs by increasing production and
    releasing into circulation adequate numbers of
    immature RBCs (aka polychromatophils)

8
Polychromatophils
  • Bluish to reddish-blue cytoplasm
  • Slightly larger than mature RBCs (why?)
  • When stained with New Methylene Blue
    Reticulocytes

9
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10
Erythrocyte Life Span
  • Stem Cell ? Rubriblast? Prorubricyte ? Rubricyte?
    Metarubricyte? Reticulocyte? RBC
  • Metarubricyte- nucleated RBC released in severe
    anemia.

11
Reticulocytes Remember these???
  • Irregular net-like structures in
    polychromatophils when stained with New Methylene
    Blue. These structures are called reticulum.
  • Reticulum is irregular clumps of ribosomal RNA
    and organelles like mitochondria.
  • Most species only have one form of reticulocyte.
    Which species has two NORMALLY?

12
Reticulocytes - continued
  • Non-regenerative anemia
  • Decreased production of erythrocytes caused by
    inadequate production of RBCs by the bone
    marrow.
  • Canine reticulocytes when stained with New
    Methylene Blue are AGGREGATE only.
  • Will appear as hyperchromatocytes and as
    macrocytes in comparison with normocytes.

13
Feline Reticulocytes
  • Punctate v. Aggregate
  • The aggregate reticulocytes mature into the
    punctate form within 12 24 hours.
  • Punctate reticulocytes circulate for 7 10 days
    before all RNA is lost.
  • Reticulocyte counts of feline blood should only
    include the percentage of aggregate reticulocytes
    as punctate reticulocytes are not counted since
    they dont reflect the most recent bone marrow
    response.
  • e.g. An anemic cat with only punctate
    reticulocytes is NOT actively regenerating RBCs
    at this time, but has shown some bone marrow
    regneration in the last 7 10 days.

14
HemorRhage anemia
  • Blood loss anemias are associated with acute,
    sub-acute and chronic hemorrhage.
  • Hemorrhage Defined as the escape of blood from
    a ruptured vessel. May be external or internal.
  • Acute Extremely sudden onset. Usually follows
    trauma or surgical procedures
  • Sub-acute Recent or rather sudden onset. May
    take hours-days for clinical signs to appear.
  • Chronic A continuous, constant loss of blood.
    Parasitism is most common cause of chronic
    anemias.

15
Hemorrhage Anemia - Continued
  • Most common cause of hemorrhage related anemia is
    trauma.
  • Can also be caused by thrombocytopenia which is
    characterized by petechial hemorrhages on ear
    pinna(e), mucous membranes, and other non-haired
    areas like the abdomen.
  • Treatment Includes steroids, plasma or whole
    blood transfusions, and avoidance of trauma.

16
Iron-deficiency anemia
  • Iron is important in the body because it is the
    main constituent of hemoglobin.
  • Caused by chronic external blood loss.
  • Note severe flea infestations, GI parasites,
    gastric ulcers and bleeding tumors can cause
    significant blood loss over time.
  • The iron and hemoglobin lost with this external
    bleeding result in the formation of altered RBCs
    and decreased life span.
  • Treatment includes correcting the cause of the
    blood loss and iron supplements.

17
Hemolytic Anemia
  • Defined The increased destruction of
    erythrocytes. (aka, hemolysis)
  • Caused by immune components attaching directly or
    indirectly to the RBC membrane, altering its
    structure.
  • The body, attempting to regain homeostasis,
    begins to remove these altered cells.
  • In cats, the most common cause of hemolytic
    anemia is Mycoplasma haemofelis, a blood born
    parasite. Feline Leukemia can also stimulate an
    immunohemolytic anemia. Treatment is aimed at
    suppressing the immune system w/ steroid therapy.
  • In dogs, the most common cause is an underlying
    inflammatory process.

18
Blood-Borne Parasites
  • Several commonly seen blood parasites can produce
    anemia through hemolysis.
  • The parasite attaches to the erythrocyte
    membrane, causing an increased destruction of the
    cells.
  • Animals having non-specific signs such as weight
    loss, anorexia, fever of unknown origin (FUO),
    hepatomegaly and splenomegaly should have blood
    films examined for the presence of blood
    parasites.

19
Toxin-induced anemia/Heinz body anemia
  • Drugs can be a source of anemia in small animals.
  • Hemoglobin will denature and form Heinz Bodies.
  • Cats are considered to be more susceptible to
    Heinz body formation due to the structure of
    their hemoglobin.
  • One of the most common Heinz body anemias seen in
    the dog is onion toxicity.
  • Acetaminophen toxicity can cause anemia in cats
    and dogs.

20
Ehrilichiosis
  • Ehrlichia is a rickettsial disease spread by the
    brown dog tick.
  • First recognized in the US in 1963 and gained
    prominence because of the large losses among
    working military dogs stationed in Vietnam.
  • Infection occurs when the organism is transported
    via the tick saliva during a blood meal.
  • Infection is initially in WBCs.
  • Can be transmitted from infected animal to
    non-infected animal.
  • Infected circulating cells can infect other
    organs and may result in platelet consumption and
    erythrocyte destruction.

21
Female Tick Laying Eggs
22
Von Willebrands Disease
  • Canine vWD is the most common inherited blood
    disorder.
  • In healthy dogs, von Willebrands factor (vWF)
    promotes platelet clumping. Decreasing amounts
    of the factor causes a bleeding disorder.
  • Has been identified in 54 breeds, with Doberman
    Pinschers, German Shepherds, and Labrador
    Retrievers being the most common.
  • Dogs with this disorder should not be bred and
    special care must be taken at times of surgery to
    ensure hemostasis.
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