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Anaemia

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Abstract

Anaemia is a common clinical and laboratory test finding which in itself does not constitute a diagnosis. The ultimate aim for the veterinary practitioner is to determine the pathogenesis of the anaemia in order to deliver the most appropriate therapy for the patient. This chapter looks at red cell production; definition of anaemia; variables that characterize anaemia; erythron disorders without anaemia; classification of anaemia; when to collect bone marrow samples and do further tests; haemopoietic neoplasia; causes of anaemia in perspective.

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Figures

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3.1 Three essential components required for haemopoiesis are stem cells, cytokines and an appropriate marrow microenvironment. The microenvironment may consist of an adequate supply of oxygen and nutrients such as iron, amino acids, glycine and vitamins B, B and folate. The nutrients required for red cell production may be considered in two categories: those needed for nucleotide synthesis; and those for haemoglobin synthesis. The end products, the mature red blood cells, are released into the peripheral circulation by migration through vascular sinusoids.
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3.2 Blood smear from a dog with moderately severe haemolytic anaemia showing a good regenerative response with many (11) large polychromatic RBCs. Platelets are missing from this field.
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3.3 Reticulocytes stained with the supravital stain new methylene blue to demonstrate RNA. There are four cells showing a classical reticular network and one with a punctate form (this cell is older and is not included in the percentage count). Punctate forms may be quantified separately in cats. Given that reticulocytes continue to mature in the circulation, reticulocyte staining will only be valid on a fresh blood sample.
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3.4 Blood smear from a non-anaemic dog showing normal distribution of red blood cells in the monolayer area of the slide. Note that there is little space between the cells to insert another red cell. Also note the degree of central pallor of the red cells and the abnormal absence of platelets in this field; the platelets were clumped at the feather end of the slide.
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3.7 Concept map of anaemia illustrating a pathway for diagnosing anaemia. Linking words are italicized. RBC, red blood cell; RPI, reticulocyte production index; Cu, copper; Co, cobalt; I/V, intravascular; E/V, extravascular
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3.8 Blood smear from a dog with iron deficiency anaemia showing severely hypochromic red cells with a wide area of central pallor. One dacryocyte (tear drop-shaped cell) is present on the left side; some cells are smaller than normal. Note the plentiful platelets.
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3.9 Blood smear from a dog with immune-mediated haemolytic anaemia showing many large polychromatic erythrocytes and smaller spherocytes; this represents a classical biphasic red cell population. Platelets are also missing from this field. They may be consumed in concurrent anti-platelet destruction or coagulopathy (disseminated intravascular coagulation and thromboemboli).
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3.10 Blood smear from a dog with a schizocyte in the centre of the field indicating mechanical red cell injury. There is a moderate regenerative anaemia associated with a vascular neoplasm, haemangiosarcoma, and there is marked poikilocytosis with many echinocytes (burr cells). Only one platelet is present in this field.
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3.11 Blood smear from a dog with severe schizocytosis associated with a malignancy, causing mechanical red cell injury and moderate anaemia.
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3.12 Blood smear from a dog with mechanical red cell injury and moderate regenerative anaemia associated with disseminated intravascular coagulation. Three horn-shaped cells, keratocytes, are present in the centre of the field. There is also moderate echinocytosis (burr cells).
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3.13 Blood smear from a dog with many acanthocytes (spur cells – star-shaped appearance with long cytoplasmic projections) with a moderate regenerative anaemia associated with splenic haemangiosarcoma.
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3.14 Blood smear from a young dog with poikilocytosis caused by hereditary elliptocytosis and a compensated anaemia.

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