Term
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Definition
| is the breaking down of red blood cells which results in the release of hemoglobin that results in red discoloration of the serum or plasma. |
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Term
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Definition
• Blood Sample: Improper sample handling or due to traumatic venipuncture
• Immune-mediated disorders
• Toxins
• Blood parasite infections
• Congenital causes
Other than hemolysis caused by improper blood sample handling, the result is usually an increase in the destruction of RBC’s and / or shortened lifespan of RBCs. |
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Term
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Definition
• Smaller RBCs that lack central pallor.
• A significant number of spherocytes is the hallmark of IMHA
• This occurs because of the RBCs are coated with antibodies and the cell membranes are pinched off by cells in the spleen and liver. |
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Term
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Definition
denatured, precipitated hemoglobin on the membranes of RBCs.
- represent oxidized hemoglobin and can be observed as rounded protruberances which deform the red blood cells
-They can readily be observed with a New Methylene Blue stain. Feline hemoglobin is particularly prone to oxidation when exposed to oxidative agents (especially acetaminophen which is toxic in cats!) because of the great number of amino acids possessing a sulfhydryl group (-SH) in this species' hemoglobin molecule
-A small number of small Heinz bodies may be clinically without consequence in cats (generally < 10%, and usually in the order of 2-3%). However, when the Heinz bodies are larger and occur with greater frequency (affecting in excess of 20-30% of the circulating red blood cells), they may contribute to the development of hemolytic anemia |
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Term
| Most cases of Heinz body formations are caused by |
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Definition
| ingestion of oxidizing substances. Not all animals with Heinz bodies develop anemia. |
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Term
| Causes of Heinz Body formations |
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Definition
Most cases of Heinz body formations are caused by ingestion of oxidizing substances. Not all animals with Heinz bodies develop anemia.
• onions / garlic
• acetaminophen
• zinc (pennies minted after 1983– see article)
• copper
• propylene glycol (preservative and carbohydrate source in pet food
• benzocaine products (topical anti-pruritic meds)
• d-L methionine
• excess Vitamin K administration
• phenols |
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Term
| Clinical signs of Heinz Body Anemia |
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Definition
Clinical signs vary depending on the oxidant involved, the amount of consumption, and the time elapsed since consumption.
Signs of anemia:
• weakness
• depression
• tachycardia
• MM pale to cyanotic (methemoglobinemia) or icteric (hyperbilirubinemia)
• tachypnea
• +/- vomiting
• +/- diarrhea |
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Term
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Definition
History of ingestion of substances
Clinical signs
CBC
Heinz bodies on blood film |
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Term
| Medical & Nursing Care of Heinz Body Anemia |
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Definition
Treat the source
Remove the source of the problem
Supportive care (fluid, transfusions, etc.) |
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Term
| Sx Tx of Heinz Body Anemia |
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Definition
| Remove zinc / copper containing foreign bodies |
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Term
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Definition
Heinz bodies are precipitates of oxidized hemoglobin. HB are seen as round projections affixed to the surface membranes of RBC’s
Heinz bodies may occur without hemolytic anemia and can be seen in some metabolic conditions such as diabetes, hyperthyroidism, lymphoma.
Onion and garlic are often used to enhance flavor in food. Many human baby foods contain these substances. |
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Term
| Be able to list some of the things that can cause hemolysis and an increased destruction of RBCs. |
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Definition
• Blood Sample: Improper sample handling or due to traumatic venipuncture
• Immune-mediated disorders
• Toxins
• Blood parasite infections
• Congenital causes |
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Term
| 2. Besides the various diseases/toxins, what common procedure can also cause a blood sample to become hemolyzed? |
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Definition
| : Improper sample handling or due to traumatic venipuncture |
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Term
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Definition
as cells circulate through spleen, liver and bone marrow they are pulled out and destroyed. occurs when red cells are destroyed within the organs of
the immune system; this is the most common form |
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Term
| Briefly describe how IMHA results in anemia. |
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Definition
- condition where the pt’s immune system starts attacking its own RBCs
- because the branch of the immune system that produces antibodies begins to direct them against the pt’s own RBCs
- as cells circulate through spleen, liver and bone marrow they are pulled out and destroyed (extravacular hemolysis)
- Their iron is sent to the liver as bilirubin for recycling. The spleen enlarges as it finds itself processing far more damaged red blood cells than it normally does. The liver is overwhelmed by large amounts of iron-pigmented bilirubin and the patient becomes jaundiced.
- these antibodies activate a special protein system called the complement system. Complement proteins are able to simply rupture red blood cells if they are adequately coated with antibodies, a process called intravascular hemolysis. Ultimately, there aren't enough red blood cells left circulating to bring adequate oxygen to the tissues and remove waste gases |
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Term
| What is the main therapy for IMHA? |
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Definition
| Corticosteroid hormones in very high doses |
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Term
| What is another name for IMHA that you may see in the literature? |
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Definition
| Autoimmune hemolytic anemia |
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Term
| Define intravascular hemolysis |
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Definition
the liberation of hemoglobin, consisting of separation of the hemoglobin from the red cells and its appearance in the plasma. occurs when red cells are destroyed within the blood
vessels |
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Term
| What laboratory abnormalities may be seen with a patient affected by IMHA? |
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Definition
Common laboratory changes include:
Anemia
Autoagglutination
Spherocytosis
Leukocytosis
Elevated Bilirubin levels
Increased liver enzymes
Coagulation abnormalities
Icteric plasma
Packed cell volume (PCV) and Hematocrit (HCT) are measures of the relative amount
of red blood cells present in the blood; normal is 40% to 60%
Spherocytes are small rounded red cells typical of IMHA
Leukocytosis is an increase in white blood cell numbers
Bilirubin is a byproduct of the hemoglobin release that occurs with red cell
destruction in IMHA; it can also be increased with liver or gall bladder disease |
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Term
| Why does anemia often result from the presence of Heinz Bodies? |
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Definition
| HzB formation impairs RBC deformability by altering intracellular fluidity, and this decrease in malleability leads to increased entrapment in narrow splenic sinusoids as blood is filtered through the spleen.6 The HzB alone may be phagocytosed by the spleen in a process called "pitting", or the entire RBC may be culled.4 Sometimes, the production of large numbers of HzBs will result in intravascular lysis of HzB-containing RBCs and an intravascular hemolytic anemia may occur. The degree of hemolysis and subsequent anemia is dependent upon the rate of formation of HzB, the size and number of HzB, and any concurrent RBC membrane damage; these characteristics are highly variable depending upon the underlying cause.9 Other direct and indirect processes that may contribute to the removal of HzB-containing RBC's include membrane skeletal protein cross-linking, lipid peroxidation, glutathione depletion, antibody binding, and cation imbalance.3 |
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Term
| What are the 3 most common causes for the development of Heinz Bodies? |
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Definition
• onions / garlic
• acetaminophen
• zinc (pennies minted after 1983– see article) |
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Term
| Pennies minted after what year may cause HBs to develop. What is the toxin? |
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Definition
| zinc (pennies minted after 1983 |
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Term
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Definition
| the yellow color that is taken up by a patient's tissues when the liver is overwhelmed with bilirubin, the iron that contains by-products of red blood cell destruction. Normally red blood cells are removed from the circulation when they become old and inflexible. Their iron is recycled in the liver. With so many red cells being destroyed, the liver is overwhelmed and bilirubin (a yellow pigment) spills out everywhere, coloring urine, gums, skin, and the eyes orange. |
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Term
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Definition
| a condition where the patient's immune system begins attacking its own red blood cells. What occurs on a microscopic level is that the branch of the immune system that produces antibodies begins to direct them against the patient's own red blood cells. |
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Term
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Definition
| Antibodies on the surface of the RBCs cause the bridging or clumping of cells |
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Term
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Definition
• Smaller RBCs that lack central pallor.
• A significant number of spherocytes is the hallmark of IMHA
• This occurs because of the RBCs are coated with antibodies and the cell membranes are pinched off by cells in the spleen and liver. |
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Term
| What conditions can commonly suppress production of RBCs by the bone marrow? |
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Definition
| Chronic disease often leads to anemia, especially in older adults. Conditions such as infections, inflammation, and cancer particularly suppress production of red blood cells in the bone marrow. |
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Term
| What are the clinical signs of anemia due to chronic diseases? |
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Definition
| Because this type of anemia develops slowly and is generally mild, it usually produces few or no symptoms. When symptoms do occur, they usually result from the disease causing the anemia rather than from the anemia itself. There are no specific laboratory tests, so the diagnosis is typically made by excluding other causes |
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Term
| 1How is the diagnosis of anemia of chronic disease made? |
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Definition
| There are no specific laboratory tests, so the diagnosis is typically made by excluding other causes |
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Term
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Definition
| When the bone marrow cells that develop into mature blood cells and platelets (stem cells) are damaged or suppressed, the bone marrow can shut down. This bone marrow failure is called aplastic anemia. |
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Term
| List some of the causes of aplastic anemia |
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Definition
| The most common cause of aplastic anemia may be an autoimmune disorder, in which the immune system suppresses bone marrow stem cells. Other causes include infection with parvovirus, radiation exposure, toxins (such as benzene), chemotherapy drugs, and other drugs (such as chloramphenicol). |
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Term
| How does the body respond when low blood oxygen levels are detected? |
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Definition
- Blood O2 content decreases, detected by kidney
- Increased production of erythropoietin
- Red bone marrow receives correction signal via increased erythropoietin
- Increased erythropoiesis results in increased # of RBCs
- RBCs have lower total O2 content |
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Term
| What is Erythropoietin? Where is it produced? |
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Definition
the hormone responsible for inducing red blood cell production by the body’s bone marrow.
Erythropoietin is primarily produced by the kidney when a drop in blood oxygen level is perceived, though 10-15% of the total erythropoietin produced comes from the liver |
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Term
| What can occur if you have kidney failure? (With regards to RBCs.) |
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Definition
| They are not produced correctly as kidneys may not produce enough or any erythropoietin |
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Term
| What is THE most important medical therapy for anemia? |
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Definition
| Correct the underlying issue |
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Term
| List the possible therapies available for the treatment of anemia. |
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Definition
Supportive Care
3. Blood transfusion
4. Oxyglobin
http://www.oxyglobin.com/
View “About Oxyglobin” and the other sections on this site.
5. Erythropoietin
http://www.marvistavet.com/html/body_erythropoietin.html
Anemia
http://www.marvistavet.com/html/body_anemia.html |
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Term
| 3. What do you have to be careful of when transfusing an animal after the first transfusion? (talk with your preceptor about this) |
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Definition
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Term
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Definition
| a sterile, intravenously administered solution consisting of chemically stabilized hemoglobin (the protein that carries oxygen) in a balanced salt solution. Unlike blood, it does not contain red blood cells. Instead, it contains cross-linked hemoglobin molecules (several tetramers bound together) that circulate in plasma and immediately transport oxygen to tissues upon infusion. |
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Term
| Does Oxyglobin take the place of a transfusion? |
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Definition
| Yes. Oxyglobin is being used both as an oxygen carrying fluid therapy and as an alternative to red blood cell transfusion (e.g., massive blood loss, immune-mediated hemolytic anemia, etc.). |
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Term
| While most of erythropoietin is produced in the kidney, where do the precursors of the hormone come from? |
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Definition
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Term
| How long does a single dose of EPO last? |
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Definition
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Term
| How long does the effect of a dose of EPO last? Why? |
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Definition
| Its effect is seen ~ 5 days later when the red cell proliferation it has induced is mature enough for release into the circulation |
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Term
| Why do antibodies to recombinant EPO develop in dogs and cats? |
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Definition
| While human recombinant EPO works reliably in dogs/cats, it is not quite the same protein as what a dog or cat would make for itself and in some pts the immune system of the pet can recognize the human protein as foreign. Antibodies may develop in response to its exposure which not only destroy the human erythropoietin but the pet’s natural erythropoietin as well. |
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Term
| In addition to a decrease in natural EPO, what other things can occur in renal disease / failure patients that can cause anemia? |
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Definition
- build-up of renal toxins is very ulcerating to the GI tract and bleeding may result
- RBCs do not have normal life spans in the presence of high levels of circulating renal toxins
- Many renal toxins directly suppress the bone marrow’s ability to produce RBCs
- Poor production of erythropoietin by the kidney |
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Term
| What is the main side effect in dogs and cats treated with EPO? Is this common? |
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Definition
- Main adverse effect is antibody production
- Generated in response to an alien protein in the body
- Problem is antibodies that are generated not just against the alien (human) erythropoietin but also against the pt’s natural erythropoietin
- Makes for a profound anemia which can only be treated with blood transfusions
- Regular monitoring to check for a sudden drop in RBC count is crucial as this is the sign that a problem is incipient and the product can be stopped while there is still time
- Has been proposed that darbepoetin (Aranesp) is less likely to cause this rxn than other recombinant erythropoietins since it differs from the human product the most
- In 1 study, 2/3 dogs tx for more than 90 days and 5/7 cats tx for over 180 days developed refractory anemia due to anti-erythropoietin antibodies.
- More common stat is 30% incidence in development of refractory anemia
- After d/c, antibodies wane over 2 – 12 months and red cell count returns to pre-tx level. Transfusions may be needed to keep pt alive |
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Term
1. List the 5 groups of superficial lymph nodes palpable in dogs and cats.
Mandibular |
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Definition
Mandibular
Superficial Cervical (pre-scapular)
Axillary
Inguinal
Popliteal |
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Term
| 1. What are other names for Lymphoma? |
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Definition
malignant lymphoma
lymphosarcoma |
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Term
| Is lymphoma common in small animals? |
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Definition
| Most common form of cancer in humans and sm animals |
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Term
| What cells become neoplastic with lymphoma? |
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Definition
lymphocytes. When lymphocytes become cancerous within a lymph node, the node swells and hardens. Malignant lymphocytes
readily travel through the lymph vessels to nearby lymph nodes. Soon all the nodes are enlarged. Ultimately, the
bone marrow (where most blood cells are formed) is affected, the immune system is destroyed, and severe
anemia and weakness claim the victim's life. |
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Term
| What are the forms of lymphoma in the dog? |
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Definition
Multicentric – usually involves multiple peripheral lymph nodes at once
Skin form (also called mycosis fungoides)
Gastrointestinal form (affecting only the GI tract)
Leukemia (bone marrow form) |
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Term
| In the cat, what is the leading cause of lymphoma now and in the past? |
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Definition
Years ago, prior to the widespread use of the
feline leukemia vaccine, the mediastinal form (a tumor in the
chest cavity) was the predominant lymphoma form and the
leading cause of lymphoma was the feline leukemia virus. Now that the virus has become less common, thanks to
more cats living indoors, effective vaccination, and readily available testing procedures, causes of lymphoma are
more obscure. Cigarette smoke in the home has been found to double a cat's risk though genetic issues;
environmental chemicals and unknown factors remain under consideration. Lymphoma can occur anywhere in the
body where there is lymph tissue. |
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Term
| List the location of lymphomas in the cat. |
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Definition
Intestinal (now most common)
Mediastinal (in the chest cavity)
Multicentric |
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Term
| What are the cells that become neoplastic in hemangiosarcomas? |
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Definition
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Term
| What commonly occurs with growths on the spleen? |
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Definition
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Term
| What is the most common site of HSA ? What are other sites? |
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Definition
Spleen
• Skin and subcutaneous forms
• Splenic forms
• Heart-based forms |
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Term
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Definition
| The sac enclosing the heart |
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