1887

Anaemia

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Abstract

Anaemia is commonly seen in feline practice. Cats often tolerate anaemia remarkably well, especially when it is chronic, so clinical signs may not be apparent until anaemia is very severe. This chapter looks at clinical presentation, classification of anaemia, diagnostic approach and selected causes of feline anaemia. : Making and examining a blood smear; Haematological assessment; Obtaining bone marrow samples.

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Figures

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5.4.1 Regenerative anaemia. The RBCs show polychromasia (black arrows), anisocytosis (variation in cell size, including macrocytes) and a nucleated form (red arrow). Polychromatic cells are likely to be aggregate reticulocytes (immature RBCs) but NMB staining is required to confirm this. Non-regenerative anaemia: the RBCs are uniformly normocytic and normochromic. (Diff-Quik; original magnification X500)
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5.4.2 Aggregate reticulocytes are identified (arrowed) by staining with new methylene blue (NMB). This cat was showing substantial regeneration. (Original magnification X500)
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5.4.3 Normal feline platelets (arrowed) are almost as large as the RBCs. (Diff-Quik; original magnification X1000, with oil immersion)
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5.4.4 A section of the feathered edge of a blood smear, showing many normal RBCs (red arrows), as well as platelet clumps (black arrows) which indicate that adequate platelet numbers are present. (Diff-Quik; original magnification X1000, with oil immersion)
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5.4.5 Disordered clumping of RBCs (arrowed) under light microscopy confirms the presence of RBC agglutination in this positive SAT. (No stain; original magnification X500)
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5.4.6 A diagnostic approach to feline anaemia. APTT = activated partial thromboplastin time; BM = bone marrow; BMBT = buccal mucosal bleeding time; CKD = chronic kidney disease; DIC = disseminated intravascular coagulation; DKA = diabetic ketoacidosis; DM = diabetes mellitus; GI = gastrointestinal; IBD = inflammatory bowel disease; IMHA = immune-mediated haemolytic anaemia; MCHC = mean cell haemoglobin concentration; MCV = mean cell volume; NI = neonatal isoerythrolysis; PCV = packed cell volume; PRCA = pure red cell aplasia; PT = prothrombin time; RBCs = red blood cells; TP = total protein.
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Image of Appearance of a good quality blood smear ready to be stained for microscopic examination. The feathered edge is indicated by arrows.
Appearance of a good quality blood smear ready to be stained for microscopic examination. The feathered edge is indicated by arrows. Appearance of a good quality blood smear ready to be stained for microscopic examination. The feathered edge is indicated by arrows.
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Image of Platelet clumping (P). This is a common finding in feline blood. Although they may be pale-staining, platelets often have a granular appearance which aids their identification. In this photo there is also ‘rouleaux’ formation (R) as the red cells line up in graceful chains; this is also a normal finding in the cat (see later). A single small lymphocyte (L) is also present. (Modified Wright’s stain; original magnification X1000)
Platelet clumping (P). This is a common finding in feline blood. Although they may be pale-staining, platelets often have a granular appearance which aids their identification. In this photo there is also ‘rouleaux’ formation (R) as the red cells line up in graceful chains; this is also a normal finding in the cat (see later). A single small lymphocyte (L) is also present. (Modified Wright’s stain; original magnification X1000) Platelet clumping (P). This is a common finding in feline blood. Although they may be pale-staining, platelets often have a granular appearance which aids their identification. In this photo there is also ‘rouleaux’ formation (R) as the red cells line up in graceful chains; this is also a normal finding in the cat (see later). A single small lymphocyte (L) is also present. (Modified Wright’s stain; original magnification X1000)
Image of Mature segmented neutrophil (N). The cytoplasm is clear to slightly pink-staining and the well segmented nucleus is densely packed with dark-staining, slightly stippled nuclear chromatin. The background red cells are all hypochromic (obvious central pallor) and some have a ‘target cell’ (T) morphology. Target cells are a non-specific finding in anaemia and lipid disorders and are most easily appreciated in cats with hypochromic red cells. (Modified Wright’s stain; original magnification X1000)
Mature segmented neutrophil (N). The cytoplasm is clear to slightly pink-staining and the well segmented nucleus is densely packed with dark-staining, slightly stippled nuclear chromatin. The background red cells are all hypochromic (obvious central pallor) and some have a ‘target cell’ (T) morphology. Target cells are a non-specific finding in anaemia and lipid disorders and are most easily appreciated in cats with hypochromic red cells. (Modified Wright’s stain; original magnification X1000) Mature segmented neutrophil (N). The cytoplasm is clear to slightly pink-staining and the well segmented nucleus is densely packed with dark-staining, slightly stippled nuclear chromatin. The background red cells are all hypochromic (obvious central pallor) and some have a ‘target cell’ (T) morphology. Target cells are a non-specific finding in anaemia and lipid disorders and are most easily appreciated in cats with hypochromic red cells. (Modified Wright’s stain; original magnification X1000)
Image of Left shift and toxic change (LSTC). The neutrophil has basophilic (blue-staining) cytoplasm, which is one of the earliest signs of toxic change. The nucleus is also unsegmented and parallel-sided, indicating that a precursor (‘band’) neutrophil has been released in response to the same increased demand. Earlier precursors have thicker, less complex nuclei. A Howell–Jolly body (HJB) is present in one of the red cells; this remnant of nuclear material may be left behind when the immature red cell expels its nucleus as it reaches maturity – low numbers are unremarkable but more may be seen with regenerative anaemias. (Modified Wright’s stain; original magnification X1000)
Left shift and toxic change (LSTC). The neutrophil has basophilic (blue-staining) cytoplasm, which is one of the earliest signs of toxic change. The nucleus is also unsegmented and parallel-sided, indicating that a precursor (‘band’) neutrophil has been released in response to the same increased demand. Earlier precursors have thicker, less complex nuclei. A Howell–Jolly body (HJB) is present in one of the red cells; this remnant of nuclear material may be left behind when the immature red cell expels its nucleus as it reaches maturity – low numbers are unremarkable but more may be seen with regenerative anaemias. (Modified Wright’s stain; original magnification X1000) Left shift and toxic change (LSTC). The neutrophil has basophilic (blue-staining) cytoplasm, which is one of the earliest signs of toxic change. The nucleus is also unsegmented and parallel-sided, indicating that a precursor (‘band’) neutrophil has been released in response to the same increased demand. Earlier precursors have thicker, less complex nuclei. A Howell–Jolly body (HJB) is present in one of the red cells; this remnant of nuclear material may be left behind when the immature red cell expels its nucleus as it reaches maturity – low numbers are unremarkable but more may be seen with regenerative anaemias. (Modified Wright’s stain; original magnification X1000)
Image of This reactive lymphocyte (L) has slightly more abundant and basophilic cytoplasm than normal. Many of the red cells in the background show Heinz bodies (HB). These are pale to lightly eosinophilic bodies on the cell surface that may apparently overlie the red cell or may be seen on the lateral aspect as a rounded projection. They are the results of oxidative damage to haemoglobin; although low numbers of small examples may be seen in normal cats, high numbers and especially large Heinz bodies suggest an added oxidative insult. Note how large and granular normal feline platelets can be (arrowed). (Modified Wright’s stain; original magnification X1000)
This reactive lymphocyte (L) has slightly more abundant and basophilic cytoplasm than normal. Many of the red cells in the background show Heinz bodies (HB). These are pale to lightly eosinophilic bodies on the cell surface that may apparently overlie the red cell or may be seen on the lateral aspect as a rounded projection. They are the results of oxidative damage to haemoglobin; although low numbers of small examples may be seen in normal cats, high numbers and especially large Heinz bodies suggest an added oxidative insult. Note how large and granular normal feline platelets can be (arrowed). (Modified Wright’s stain; original magnification X1000) This reactive lymphocyte (L) has slightly more abundant and basophilic cytoplasm than normal. Many of the red cells in the background show Heinz bodies (HB). These are pale to lightly eosinophilic bodies on the cell surface that may apparently overlie the red cell or may be seen on the lateral aspect as a rounded projection. They are the results of oxidative damage to haemoglobin; although low numbers of small examples may be seen in normal cats, high numbers and especially large Heinz bodies suggest an added oxidative insult. Note how large and granular normal feline platelets can be (arrowed). (Modified Wright’s stain; original magnification X1000)
Image of This eosinophil (E) displays the polymorphic nucleus, usually seen as similar to neutrophils but with fewer lobules, and the cytoplasm packed with brightly eosinophilic pink-staining granules. (Modified Wright’s stain; original magnification X1000)
This eosinophil (E) displays the polymorphic nucleus, usually seen as similar to neutrophils but with fewer lobules, and the cytoplasm packed with brightly eosinophilic pink-staining granules. (Modified Wright’s stain; original magnification X1000) This eosinophil (E) displays the polymorphic nucleus, usually seen as similar to neutrophils but with fewer lobules, and the cytoplasm packed with brightly eosinophilic pink-staining granules. (Modified Wright’s stain; original magnification X1000)
Image of In this basophil (B), the complex segmented nucleus is partially obscured by violet-staining granules. (Modified Wright’s stain; original magnification X1000)
In this basophil (B), the complex segmented nucleus is partially obscured by violet-staining granules. (Modified Wright’s stain; original magnification X1000) In this basophil (B), the complex segmented nucleus is partially obscured by violet-staining granules. (Modified Wright’s stain; original magnification X1000)
Image of This monocyte (M) has an open-appearing nuclear chromatin. The blue–grey staining cytoplasm is relatively abundant and small vacuoles can be seen. (Modified Wright’s stain; original magnification X1000)
This monocyte (M) has an open-appearing nuclear chromatin. The blue–grey staining cytoplasm is relatively abundant and small vacuoles can be seen. (Modified Wright’s stain; original magnification X1000) This monocyte (M) has an open-appearing nuclear chromatin. The blue–grey staining cytoplasm is relatively abundant and small vacuoles can be seen. (Modified Wright’s stain; original magnification X1000)
Image of Rouleaux (R): stacked red cells. Three lymphocytes (L) of unremarkable morphology are also present. (Modified Wright’s stain; original magnification X1000)
Rouleaux (R): stacked red cells. Three lymphocytes (L) of unremarkable morphology are also present. (Modified Wright’s stain; original magnification X1000) Rouleaux (R): stacked red cells. Three lymphocytes (L) of unremarkable morphology are also present. (Modified Wright’s stain; original magnification X1000)
Image of Blister cell (B), acanthocyte (A), schistocyte (S). (Modified Wright’s stain; original magnification X1000)
Blister cell (B), acanthocyte (A), schistocyte (S). (Modified Wright’s stain; original magnification X1000) Blister cell (B), acanthocyte (A), schistocyte (S). (Modified Wright’s stain; original magnification X1000)
Image of Keratocyte (K), blister cell (B). (Modified Wright’s stain; original magnification X1000)
Keratocyte (K), blister cell (B). (Modified Wright’s stain; original magnification X1000) Keratocyte (K), blister cell (B). (Modified Wright’s stain; original magnification X1000)
Image of Ovalocytes (O) and echinocytes (E). Basket cells (B) are nuclear remnants of disrupted leucocytes and are usually not clinically significant. (Modified Wright’s stain; original magnification X1000)
Ovalocytes (O) and echinocytes (E). Basket cells (B) are nuclear remnants of disrupted leucocytes and are usually not clinically significant. (Modified Wright’s stain; original magnification X1000) Ovalocytes (O) and echinocytes (E). Basket cells (B) are nuclear remnants of disrupted leucocytes and are usually not clinically significant. (Modified Wright’s stain; original magnification X1000)
Image of Echinocytes (E), Heinz bodies (HB) and Howell– Jolly bodies (HJB). (Modified Wright’s stain; original magnification X1000)
Echinocytes (E), Heinz bodies (HB) and Howell– Jolly bodies (HJB). (Modified Wright’s stain; original magnification X1000) Echinocytes (E), Heinz bodies (HB) and Howell– Jolly bodies (HJB). (Modified Wright’s stain; original magnification X1000)
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Image of Alternative view of above photograph, to show the position of needle insertion into the proximal humerus.
Alternative view of above photograph, to show the position of needle insertion into the proximal humerus. Alternative view of above photograph, to show the position of needle insertion into the proximal humerus.
Image of This image is for illustrative purposes only and was taken after collection of a bone marrow sample in another cat. It shows the skeletal landmarks overlying the cat’s forelimb. The proximal humerus is made more accessible and laterally prominent if the elbow is pushed medially, as shown here, by an assistant during the procedure. If so, it is important that the assistant maintains the limb in the same position throughout the procedure.
This image is for illustrative purposes only and was taken after collection of a bone marrow sample in another cat. It shows the skeletal landmarks overlying the cat’s forelimb. The proximal humerus is made more accessible and laterally prominent if the elbow is pushed medially, as shown here, by an assistant during the procedure. If so, it is important that the assistant maintains the limb in the same position throughout the procedure. This image is for illustrative purposes only and was taken after collection of a bone marrow sample in another cat. It shows the skeletal landmarks overlying the cat’s forelimb. The proximal humerus is made more accessible and laterally prominent if the elbow is pushed medially, as shown here, by an assistant during the procedure. If so, it is important that the assistant maintains the limb in the same position throughout the procedure.
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Image of The stylet is shown adjacent to the needle, to illustrate how far the needle has been inserted.
The stylet is shown adjacent to the needle, to illustrate how far the needle has been inserted. The stylet is shown adjacent to the needle, to illustrate how far the needle has been inserted.
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Image of Here the probe is seen coming out of the needle lumen at the handle end to push the core sample out into the formalin pot.
Here the probe is seen coming out of the needle lumen at the handle end to push the core sample out into the formalin pot. Here the probe is seen coming out of the needle lumen at the handle end to push the core sample out into the formalin pot.
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