Small Animal Emergency and Critical Care Medicine: Self-Assessment Color Review, Second Edition, Q&A 18

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Student tip: This case is showing anaemia causes and performance of a saline agglutination test.

A 4-year-old male neutered Cocker Spaniel presents because of decreased activity and appetite. T = 39.9°C (103.9°F); HR = 170 bpm; RR = 60 bpm; CRT = 3sec; MM pale yellow and dry; femoral pulse bounding; perfusion hyperdynamic; estimated 6% dehydrated (MM moisture/skin turgor). A II/VI left systolic heart murmur with normal lung sounds are heard on auscultation. Initial database: PCV = 0.14 l/l (14%); TS = 78 g/l (7.8 g/dl); hemolyzed serum; BUN = 16 mmol/l (45 mg/dl); glucose = 5.3 mmol/l (95 mg/dl).

Question	Answer		Article
List at least two pathologic mechanisms that cause anemia.	Inadequate production of RBCs (e.g. selective erythropoietic depression, insufficient erythropoietin release, bone marrow failure); excessive loss of RBCs (e.g. shortened lifespan, hemorrhage); increased destruction (intravascular or extravascular hemolysis).		Link to Article
What are the RBC morphologic indicators of a regenerative process in anemia?	Macrocytosis, hypochromia, polychromasia, reticulocytosis.		Link to Article
Fill in the chart above comparing changes seen during acute hemorrhage versus hemolysis.	Total protein: DOWN versus Normal or UP. Plasma colour: Clear versus Icteric or hemolyzed. Reticulocyte response (brisk or less brisk): Less brisk (3-5 days) versus Brisk. RBC morphology: Normal Polychromasia (after 2 – 7 days) versus Spherocytes/Heinz bodies/eccentrocytes/schistocytes/+/- auto-agglutination.		Link to Article
List the broad categories of causes of RBC hemolysis.	Immune-mediated hemolytic anemia; alloimmune hemolysis (also called neonatal isoerytholysis, rare in dogs); microangiopathic/fragmentation hemolysis (DIC, dirofilariasis, neoplasia); metabolic (hypophosphatemia, osmotic lysis); toxins/drugs (acetaminophen, onions, zinc, lead); infection (blood parasites, viral, rickettsial disease); hereditary enzyme deficiencies.		Link to Article
How is a saline agglutination slide test performed, and what does it demonstrate?	A drop of patient blood is placed on a slide and mixed with a drop of isotonic saline. Macroagglutination is indicated by visualizing clumping of red cells on the slide and microscopic evaluation to distinguish true agglutination from rouleaux formation.		Link to Article

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