TOP 10 TIPS TO EVALUATE ANEMIA IN SMALL ANIMAL PATIENTS
GARRET PACHTINGER, VMD, DACVECC Chief Operating Officer, Co-Founder VETgirl
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4 A slide agglutination test is another cost-effective test you should have in your anemia “toolbox.” Especially if hemolysis is suspected (low PCV, normal TP, icteric serum/patient). To perform a slide agglutination, a drop of anticoagulated blood from a purple top tube or capillary tube is mixed with a drop of 0.9% NaCl. 5 Don’t forget to simply look at your patient! Ask yourself, “does the patient look way better than you would expect with a PCV that low?” Simply put, clinical signs vary depending on severity and acute or chronic occurrence of the anemia. If the patient has a PCV of 12 and is happy, BAR, grooming, eating…then you are likely dealing with a more chronic and non- regenerative anemia! 6 A regenerative response is not immediate. It takes up to 3 days after the anemia develops for the bone marrow to respond. A reticulocyte count > 80 × 10 9 /l is indicative of regeneration. 7 Heinz-body anemia commonly occurs secondary to toxin exposure including zinc, garlic, onion, or acetaminophen. Zinc is the main metal component of pennies, not copper and any patient showing a Heinz-body anemia should be evaluated for penny ingestion. 8 There is no specific number in which every patient should receive a red blood cell transfusion for anemia. Simply put, there is no “transfusion trigger.” Each patient must be assessed individually for factors that would warrant a transfusion including hemoglobin concentration, hematocrit, CvO2, lactate concentration, lactate, blood pressure, heart rate, pulse quality, etc. 9 Blood transfusion therapy is not without risk. Although most are familiar with more subtle transfusion reactions (e.g. transient pyrexia, hemolysis, transfusion-associated circulatory overload (TACO), facial edema, vomiting), TRALI, defined as transfusion-related acute lung injury, is another concern. TRALI is defined as new acute lung injury that occurs within 6 hours of transfusion of one or more blood products resulting in hypoxemia and non-cardiogenic pulmonary edema. 10 Don’t forget the importance of fluid therapy. Intravenous fluid support will provide improved circulation of the red blood cells that remain. If fluid therapy alone does not improve tissue oxygenation and clinical signs, a blood transfusion should be considered.
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