Term
| How do you tell the difference b/n hematuria and pigmenturia? |
|
Definition
| -spin it and hematuria with make a pellet at the bottom |
|
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Term
| What are the abnormalities seen on a blood smear of extravascular hemolysis IMHA case? |
|
Definition
-spherocytosis
-hyperbilirubinemia
-bilirubinuria |
|
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Term
| How does intravascular IMHA occur? |
|
Definition
|
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Term
| What abnormalities are seen on a blood smear of an intravascular hemolytic IMHA case? |
|
Definition
-hemoglovinemia
-hemoglobinuria
-ghost cells |
|
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Term
| Does extravascular or intravascular IMHA have a worse prognosis? |
|
Definition
|
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Term
| What are the clinical signs associated with IMHA? |
|
Definition
-signs of anemia: lethargy, exercise intolerance, weakness, collapse, pica (cats), icterus, bleeding
-pigmentura
-GI signs
-hepatomegaly, splenomegaly
-lymphadenopathy
-fever |
|
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Term
|
Definition
-PCV/TP
-saline agglutination: cluster of grapes
-rBC morphology |
|
|
Term
| How do we perform an autoagglutination test? |
|
Definition
| -1-5 drops of saline + 1 dorp EDTA blood |
|
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Term
| How will an IMHA CBC come back? |
|
Definition
-macroscopic, hypochromic anemia
-regenerative anemia: polychromasia, reticulocyte count
-RBC morphology: sperocytes (ex) or ghost cells (in)
-thrombocytopenia
-moderate to marked leukocytosis |
|
|
Term
| Which RBC morphology is characteristic of extravascular hemolytic IMHA? What about intravascular IMHA? |
|
Definition
-extravascular hemolysis = spherocytes
-intravascular hemolysis = ghost cells |
|
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Term
| How does the chem panel of an IMHA case come back? |
|
Definition
-hyperbilirubinemia: BOTH extra and intravascular
-inc ALT and ALP
-electrolyte imbalances: anorexia, dirrhea, vomiting |
|
|
Term
| How does the UA of an IMHA case come back? How is it used to distinguishe intravascular and extravascular hemolytic IMHA? |
|
Definition
-bilirubinura: BOTH intra and extra
-hemoglobinuria: intra ONLY |
|
|
Term
| What are the 3 diagnostics used to confirm an IMHA case? |
|
Definition
-spherocytosis
-autoagglutination
-detection of anti-erythrocyte antibodies |
|
|
Term
| What are some possible secondary causes of IMHA? |
|
Definition
-neoplasia: PE, thoracic rads, abdominal ultrasound
-drug and vaccine history
-ifnectious diseases |
|
|
Term
| What are the 4 categories of acute IMHA management? |
|
Definition
***immunosuppression
-adjunctive immunomodulatory therapy
***thromboprohylaxis
-supportive care |
|
|
Term
| What drugs are our primary immunosupprassion agent for treating IMHA? |
|
Definition
-flucocorticoid: prednisone, dexamethasone
-/+ 2nd agent: azathioprine, cyclosporine |
|
|
Term
| Why would we add a second line drug in immunosuppression therapy of IMHA? |
|
Definition
-improved immunosuppresion for severe cases
-steroid sparing: adverse effects are a concern in larger dogs & compensate for concurrent diseases |
|
|
Term
| How do we implement adjunctive immunomodulatory therapy in acute management of IMHA? |
|
Definition
-give human intravenous immunoglobulin (IgG) to block the Fc receptors in splenic macrophages
-too expensive & risk of hypersensitivity |
|
|
Term
| Why is thromboprophylactic treatment of IMHA so important? Why? |
|
Definition
-risk of thromboembolism = leaidng cause of natural death in IMHA
-due to vascular injury (cytokines, hypoxia), blood stasis (IV catheter), hypercoagulable |
|
|
Term
| How do we implement thromboprophylactic treatment of IMHA? |
|
Definition
-platelet inhibition: Clopidogrel, or low dose aspirin
-possibly heparin |
|
|
Term
| How does Clopidogrel work? |
|
Definition
| -irreversible platelet inhibition |
|
|
Term
| How do we implement supportive care for acute management of IMHA? |
|
Definition
-IV fluids: hydration, electrolyte balance
-RBC transfusions PRN: pRBC > whole blood, some patients may need multiple
-others PRN: gastroprotectants, anti-emetics |
|
|
Term
| How do we chronically manage IMHA? |
|
Definition
-gradual taper of immunosupprassive drugs once PCV is normal
-typically reduce by 20-25% every 2-4w
-if on multiple drugs, taper steroids first |
|
|
Term
| When do you determine that a patient CAN'T be tapered off of immunosuppressive therapy completely? |
|
Definition
| -you can't! if they relapse, then you find out but it is ideal to try to get a patient off of therapy completely |
|
|
Term
| What are the important facets of client education regarding IMHA? |
|
Definition
-VERY important!
-not a quick-fix dz: expensive and long-term meds and follow-up
-glucocorticoid side effects
-importance of gradual taper of meds
-importance of follow-up
-predisposition to immune-mediated diseases |
|
|
Term
| Describe the prognosis of IMHA? |
|
Definition
-guarded to fair
-30-50% mortality rate |
|
|
Term
| What are the leading causes of death in IMHA cases? |
|
Definition
-euthanasia
-thromboembolism |
|
|
Term
| What factors are associated with worse prognosis in IMHA cases? |
|
Definition
| -intravascular hemolysis, autoagglutination, hyperbilirubinemia, thombocytopenia, inc ALP |
|
|
Term
| Are most feline cases of IMHA primary or secondary? Causes? |
|
Definition
-secondary
-caused by infetions: Mycoplasma spp, FeLV, Cytauxzoon felis |
|
|
Term
| Which cats are predisposed to feline IMHA? |
|
Definition
|
|
Term
| What chem results are typical of secondary feline IMHA? |
|
Definition
| -initially non-regen anemia, thrombocytopenia, neutropenia, leukocytosis |
|
|
Term
| How do we diagnose feline IMHA? |
|
Definition
-autoaglgutination
-spherocytes difficult to detect in cats
-rule out secondary IMHA before dx primary IMHA |
|
|
Term
| How do we treat primary feline iMHA? Secondary? |
|
Definition
-primary: prednisolone +/- cyclosporine
-secondary: treat infection +/- prednisolone |
|
|
Term
| What causes neonatal isoerythrolysis in felines? |
|
Definition
| -Type A kittens born to Type B queens |
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