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Hemolymphatics
Questions about the final
119
Veterinary Medicine
Professional
03/25/2012

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Term
Name the clinical signs of immune-mediated hemolytic anemia
Definition
Depression, Weakness, Lethargy, Anorexia, Pale MM, bounding pulses, tachychardia, tachypnea, fever, icterus, dark red/yellow/brown urine, petechiae (with concurrent thrombocytopenia)
Term
Sex, Age, and Breed for number-one signalment of IMHA in small animal?
Definition
Female (spayed), middle-aged, cocker spaniels
Term
Diagnostic tests for IMHA? (Name 5)
Definition
Coomb's test; autoagglutination (negates need for Coomb's test); presence of spherocytes; signs of intravascular hemolysis (hemoglobinemia, hemoglobinuria); Inflammatory leukogram
Term
What's unique about diagnosing IMHA in cats?
Definition
Difficult to recognize spherocytes in the cat, because their RBCs already lack central pallor
Term
First treatment for IMHA in SA?
Definition
Treat the underlying cause! (Primary or secondary)
Term
Treatment options for IMHA?
Definition
(Treat underlying disease!), IV fluids? (controversy), Cage rest, oxygen if needed, transfusion if indicated, immunosuppressive drugs (steroids), Heparin
Term
What category of drugs is the mainstay treatment for IMHA?
Definition
Glucocorticoids
Term
Which specific drug is good for maintenance with IMHA?
Definition
Azathioprine
Term
When do we use Intravenous human immunoglobulin (hIVGG)? What is it exactly?
Definition
We use it in IMHA when we have lack of results with other drugs (it's expensive though!). It is purified human IgG
Term
When is a splenectomy used with IMHA?
Definition
Chronic problems
Term
What are the 2 main complications of IMHA?
Definition
DIC, Thromboembolic disease
Term
What's the mortality of IMHA?
Definition
Moderate to high, 20-50%.
Term
Name some poor prognostic indicators (up to 8)
Definition
1) High bilirubin (>5 mg/dl), 2) autoagglutination, 3) Intravascular hemolysis, 4) Hypoalbuminemia, 5) Thrombocytopenia 6) Lower PCV, 7) Low reticulocyte values, 8) rapid hemolysis
Term
With kitten neonatal isoerythrolysis, what blood type does the queen, father, and neonate typically have?
Definition
Queen = type B, Father = type A, Neonate = type A
Term
Do we need to worry about NI in cats if it's the queen's first litter? Why or why not?
Definition
Yes, because cats have naturally occurring anti-A alloantibodies.
Term
What is the hallmark sign of kittens with NI?
Definition
Dark, reddish-brown urine
Term
Name the clinical signs of NI in kittens (6)
Definition
1. Sudden death w/n 24 hours (due to anemia, DIC, acute renal failure) 2. Fading kitten syndrome 3. ** Dark, reddish-brown urine 4. Pale MM 5. Icterus 6. Tail-tip necrosis
Term
Treatment options for kittens with NI?
Definition
1. Separate affected kitten from mother for first 2-3 days after birth and use milk replacer 2. Supportive care 3. Blood transfusion if needed
Term
How do you diagnose NI in kittens? Include during necropsy.
Definition
Clinical signs. Positive slide agglutination test and positive Coomb's test. At necropsy, liver and splenic erythrophagocytosis and extramedullary hematopoiesis, nephropathy.
Term
What type of cats are especially susceptible to NI?
Definition
Devon rex (British origin), curly coats, and exotic short hairs
Term
What is methemoglobin?
Definition
Hemoglobin in which the iron component of the heme group has been oxidized from the ferrous to the ferric state
Term
What are the causes of methemoglobinemia?
Definition
1. Increased production of methemoglobin by oxidants 2. Decreased reduction of methemoglobin due to a decrease in the RBC methemoglobin reductase enzyme (can be inherited)
Term
Primary differentials for methoglobinemia?
Definition
Causes of hypoxemia
Term
Would oxygen help methoglobinemic patients?
Definition
NO
Term
Clinical signs of methemoglobinemia?
Definition
May be inapparent. If there are signs: cyanotic MM, lethargy, tachycardia, tachypnea, ataxia, stupor/coma/death
Term
Laboratory signs of methemoglobinemia?
Definition
1. Anemia (if oxidant drug) or mildly elevated PCV 2. Heinz bodies 3. Elevated BUN/ALT 4. Brown-colored blood (if methemooglobin >10% of total hemoglobin) 5. Can measure methemoglobin reductase activity in certain labs
Term
How do you treat methemoglobinemia?
Definition
If mild or if inherited: no treatment. Discontinue any suspected oxidant drug. Fluids, supportive care. NOT oxygen. If due to oxidant drugs may use N-acetylcysteine and/or absorbic acid or methylene blue
Term
What is the type of hypersensitivity in lupus? What is the pathogenesis?
Definition
Type 3 hypersensitivity. Immune antigen-antibody complexes deposit in the glomerular basement membrane, synovial membrane, skin and blood vessels. Immune complexes activate complement --> attracts neutrophils --> causes tissue damage via release of proteolytic/hydrolytic enzymes
Term
Signalment with lupus: Species/Breeds/Age
Definition
Cat or dog; Collies/shelties/GSD; mean age 6 years but any age
Term
Differentials of lupus
Definition
Varies with signs, but most often neoplasia and infectious diseases
Term
Clinical signs of lupus
Definition
Waxing and waning! Varies with site of immune complex deposition (Lethargy, anorexia, shifting leg lameness/swollen joints, dermatological manifestations (ULCERS, alopecia, necrosis on ear tips, seborrhea, pruritis), fever, lymphadenopathy, hepatosplenomegaly, arrythmias/heart murmurs, muscle wasting
Term
Diagnostic tests for lupus?
Definition
1. Antinuclear antibody test (ANA) - often positive 2. Skip biopsy with direct immunoflorescence testing or peroxidase 3. Clinical signs
Term
Does lupus have regenerative or nonregenerative anemia?
Definition
Both
Term
How do you treat lupus?
Definition
Supportive care, Immunosuppressive drugs like IMHA (corticosteroids, azithiaprine, cyclosporine)
Term
What are the laboratory results you will see with lupus?
Definition
Regenerative or non-regenerative anemia; leukocytosis or leukopenia and/or thrombocytopenia; proteinuria (which can cause muscle wasting); May have positive Coomb's test with IMHA
Term
What are the causes of marrow toxicity?
Definition
1. Infectious 2. Non-infectious (Toxins, irradiation)
Term
How is Ehrlichia canis transmitted? Be specific.
Definition
By tick - esp. the brown dog tick (Rhipicephalus sanguineus)
Term
How do you diagnose Ehrlichia canis?
Definition
1. Serology (IFA, ELISA, intra-cytoplasmic morulae in monocytes - can check buffy smears, PCR, cell culture, Western immunoblotting)
Term
What cells do Ehrlichia canis infect?
Definition
Monocytes
Term
What are the drugs used to treat E. canis? Which one should you use if you aren't sure if it's Ehrlichia?
Definition
Can use Doxycycline or Imidocarb diproprionate (pre-treated with atropine or glycopyrollate). Use Imidocarb if you aren't sure if it's Ehrlichia.
Term
What is the most consistent laboratory finding in E. canis? What are some other possible lab findings?
Definition
Thrombocytopenia. Also mild leukopenia, anemia, hyperglobulinemia (polyclonal gammopathy), hypoalbuminemia
Term
How soon can you detect IgG antibodies after an Ehrlichia infection?
Definition
~14 days post-infection
Term
Which disease that we discussed induces vasculitis?
Definition
Ehrlichia canis
Term
Treatment of Babesia canis vs. Babesia gibsoni?
Definition
B. canis = Imidocarb, B. gibsoni = Atovaquone, Azithromycin or Clindamycin
Term
What is the reservoir of Cytauxzoon felis?
Definition
Bobcat
Term
What is the treatment of Cytauxzoon felis?
Definition
Supportive care, possibly atovaquone?
Term
How do you get rid of the carrier state in Babesia canis?
Definition
You can't
Term
How is Babesia gibsoni transmitted?
Definition
Fighting - blood transmission
Term
How is EIA transmitted?
Definition
Blood meal from tabadids, iatrogenic
Term
What is the most common type of EIA infection? (AKA acute, chronic, subclinical, etc)
Definition
Subclinical! Most horses will look normal!
Term
What type of virus is EIA?
Definition
Retrovirus (Lentivirus)
Term
What are the clinical signs of acute EIA?
Definition
Fever, lethargy, anorexia, THROMBOCYTOPENIA, Petechial hemorrhages, +/- anemia, SUBCLINICAL, seroconversion after 40 days
Term
When do you see thrombocytopenia in EIA?
Definition
Usually with each recurring febrile episode
Term
What are the initial diagnostic tests for an anemic patient?
Definition
CBC, Evaulation of blood smear, Reticulocyte count
Term
American cats are usually type ___ and British cats are usually type ___
Definition
American = type A, British = type B
Term
Where is Hemobartonella felis located in a blood smear?
Definition
Epicellular on RBC
Term
Where is Babesia canis located in a blood smear?
Definition
Intracellular in RBC
Term
What is the number one cause of zinc toxicity in dogs?
Definition
Ingestion then erosion of pennies post-1983
Term
What are the clinical signs of zinc toxicity?
Definition
Pale MM, vomiting, diarrhea, anorexia, hemoglobinuria, Hematuria, Icterus, cardiac arrythmias
Term
What would you see in a blood smear of a dog with zinc toxicity?
Definition
Basophilic stipling, target cells, increased nRBCs
Term
Heinz body anemia: dogs vs. cats?
Definition
Dog are more resistant to Heinz body formation than cats because the hemoglobin of cats is more easily oxidized
Term
The most common cause of Heinz body anemia in is ______ in the cat and _______ in the dog
Definition
Oxidant drugs (esp. acetominophen) = cats, onion ingestion = dogs
Term
How do you definitively diagnose Heinz body anemia in cats?
Definition
Heinz bodies and regenerative anemia (BOTH)
Term
Clinical signs in Heinz body anemia?
Definition
Sudden onset! Pale MM, weakness, anorexia, fever, hemoglobinemia/nuria, cyanosis w/ methoglobinemia
Term
What are the clinical signs of acetaminophen toxicity?
Definition
Methemoglobinemia, dyspnea, FACIAL EDEMA, depression, hypothermia, vomiting
Term
How do you treat Heinz body anemia? How do you treat acetominophen toxicity specifically?
Definition
Remove source of oxidant (can do charcoal if ingested in last 2 hours); supportive care (oxygen, fluids); If acetominophen toxicity: N-acetylcysteine, ascorbic acid
Term
What is the pathogenesis of hypophosphatemia?
Definition
Can cause ATP depletion and adversely affect high energy using cells such as RBCs (hemolysis), skeletal muscle cells (weakness, respiratory paralysis), and brain cells (seizures, altered mentation)
Term
What are the clinical signs in hypophosphatemia?
Definition
(Varies with underlying cause). Pale MM, tachypnea or dyspnea, MUSCLE WEAKNESS, mental dullness
Term
How do you treat mild hypophosphatemia? Severe?
Definition
If mild? Skim milk or sodium or phosphate supplements. If severe? IV balanced electrolyte solution for 6 hours (monitor P, Ca, K levels)
Term
What are the breeds affected with pyruvate kinase deficiency?
Definition
#1 = basenjis, Westies, and beagles
Term
What are the clinical signs of PK deficiency?
Definition
BREED!! < 1 year, exercise intolerance, retarded growth, pale MM, tachycardia, hepatosplenomegaly, HIGHLY regenerative anemia
Term
What is the breed associated with phosphofructokinase deficiency?
Definition
English springer spaniel
Term
How do you treat PK deficiency?
Definition
No treatment
Term
How do you treat PFK deficiency?
Definition
Avoid situations inducing hyperventilation. Also, administer acetazolamide prior to anticipated episodes.
Term
What are the clinical signs of PFK deficiency?
Definition
BREED, noticed at young age! Exercise intolerance and bilirubinuria which develop following episodes of hyperventilation accompanying exercise, excessive barking and elevated temperature (transient hemoglobinemia and hemoglobinuria, hepatosplenomegaly, anemia and icterus, bilirubinuria and reticulogytosis may persist, rarely muscle cramps)
Term
What is the prognosis of PK deficiency? What is the prognosis of PFK deficiency?
Definition
PK = poor prognosis, PFK = fair to good prognosis
Term
What is the breed associated with familial nonspherocytic anemia?
Definition
Miniature poodles
Term
How can you transmit Hemobartonella felis?
Definition
Ticks, blood transfusions, queen-to-kittens
Term
What are the most common blood types in horses?
Definition
Aa and Qa
Term
What are the differential dx for neonatal isoerythrolysis in horses?
Definition
SEPSIS, Hypoxic-ischemic encephalopathy, Meningitis, EHV-1, Hemorrhage
Term
How do you treat NI in horses?
Definition
Blood transfusion with a compatible donor (Aa and Qa negative) or dam with washed RBCs; Antimicrobials; Fluid/nutritional support; Nasal oxygen; Stall confinement; Oxyglobin; Seizure rx
Term
If it's a mare's first foal, do we need to worry about NI?
Definition
Not usually (Unlike cats!!!)
Term
What's the difference between acute and gradual NI in horses?
Definition
Acute involves hemolysins (and 80% of cases). Gradual involves agglutinins.
Term
When do clinical signs for NI in horses usually show up?
Definition
5 hours to 5 days
Term
What are the clinical signs of NI in horses?
Definition
Peracute hemolysis (shock, acute death), weakness/lethargy, icterus, tachycardia/tachypnea, pallor, anemia, pigmenturia, rare seizures
Term
According to Dr. Holbrook, what does a PCV of <20 usually mean?
Definition
Hemolysis
Term
What test predicts the likelihood of NI in horses?
Definition
Jaundice foal agglutination test
Term
What are the top 2 hemolymphatic diseases in horses?
Definition
Coagulopathy, neoplasia
Term
What is the most common immunodeficiency in horses?
Definition
Failure of Passive Transfer
Term
What is your #1 concern with FPT?
Definition
Risk of sepsis!! Treat as if there is sepsis!
Term
What can cause agalactia in horses and thus FPT?
Definition
Fescue toxicity
Term
What are the causes of FPT?
Definition
Inadequate colostral intake, Leaking prior to parturition, Agalactia (fescue toxicity), Poor quality, Poor absorption
Term
How do you diagnose FPT?
Definition
Snap test ELISA; (IgG less than 800 mg/dl at 24 hours)
Term
How do you treat FPT (AND SEPSIS!!!)?
Definition
In first 24 hours = oral colostrum, EARLY INTERVENTION; Broad spectrum antimicrobials, fluid support, pressor support (dopamine, dobutamine, NE, vasopressin), Nutritional support (IV PPN or TPN)
Term
What are the clinical signs of SCID?
Definition
At 1-3 months: failure to thrive, recurrent infections
Term
What is the signalment of SCID in horses?
Definition
Arabian, Foals 2-4 months of age
Term
What are the lab results in SCID?
Definition
Lymphopenia (B and T cells), Low immunoglobulins (IgM absent if sample is presuckle or it decreases over 2-4 weeks)
Term
How can you diagnose SCID?
Definition
Genetic testing, PCR and southern blotting, whole blood
Term
When is the clinical onset of IgM deficiency?
Definition
2-8 months of age OR 2-5 years of age
Term
What is the classic clinical sign of selective IgM deficiency in foals?
Definition
Pneumonia! (esp. doesn't respond to antimicrobials) May develop sepsis. Many die by 2 years
Term
What is the classic clinical sign of selective IgM deficiency in adults?
Definition
Lymphoma! (Lymphadenopathy, weight loss)
Term
What is the age and sex of those affected by X-linked aggammaglobulinemia?
Definition
Males, 2-6 months of age
Term
What is missing in X-linked aggamaglobulinemia?
Definition
Lack B cells and plasma cells, No IgM, No IgA (IgG declines with age, post-colostral)
Term
Which is more common in DIC in horses: hypercoagulation or bleeding?
Definition
Hypercoagulation
Term
What is DIC most commonly associated with?
Definition
Severe endotoxemia/sepsis
Term
What are the common causes of hemolysis in horses?
Definition
IMHA, Oxidative injury
Term
How do you treat red maple toxicosis?
Definition
Remove source, Charcoal to exposed, fluid support, blood transfusions, VITAMIN C
Term
Which is higher in oxidative injury? Fe+2 or Fe+3?
Definition
Fe +2
Term
What are the clinical signs of red maple toxicosis? Laboratory signs?
Definition
Pigment nephropathy, laminitis, acute death, colic/diarrhea. In the lab: hemoglobinuria, bilirubinemia, bilirubinuria, Heinz bodies
Term
How do you treat equine piroplasmosis?
Definition
Imidocarb diproprionate
Term
What are the clinical signs of lymphosarcoma in horses?
Definition
Lethargy, weight loss, ventral edema, organ dependent signs
Term
What is the clinical pathology of lymphosarcoma in horses?
Definition
VARIABLE! Chronic inflammation, Often low IgM, normal to low lymphocytes, (RARE: leukemia, neoplastic cells)
Term
For horses to enter OK, how current does their health certificate need to be? Negative cELISA? Negative EIA?
Definition
10 days, 14 days, 12 months
Term
What are the main clinical signs of hemolysis in the horse?
Definition
Hemoglobinemia/hemoglobinuria, Hyperbilirubinemia (indirect), pale MM or icteric, tachycardia
Term
What are the clinical signs of CHRONIC EIA?
Definition
Recurrent fever, weight loss, ventral edema, anemia
Term
What are the differential dx for weight loss in a horse?
Definition
Decreased intake, Maldigestion/malabsorption, Increased rate of loss, chronic organ failure
Term
How does EIA cause ventral edema? What does this lead to?
Definition
Vasculitis (increased permeability). This is what causes thrombocytopenia
Term
How do you treat EIA?
Definition
Don't treat - usually euthanize or quarantine
Term
How do you test for EIA?
Definition
AGID, c-ELISA, Ab (be aware of passive immunity in foals but pregnant mares can pass it on)
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