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SA Hematology
Exam 2
94
Veterinary Medicine
Graduate
10/09/2012

Additional Veterinary Medicine Flashcards

 


 

Cards

Term
List/describe the types of Immune Mediated Non-erosive polyarthropathies
Definition
-Type I Idiopathic (65%)
-Type II assoc. w/infxn (UTI,
endocarditis, other) (10%)
-Type III hepatic/GI assoc. (4%)
-Type IV distant neoplasia (2%)

-Misc. categories
-tick borne dz-exposure vs infxn;
50% positive
-SLE (systemic lupus erythematosus)
(8%)
-vaccine/drug induced (4%)
-early erosive (2%)
Term
What is the most common type of immune mediate polyarthropathy (IMPA)?
Definition
Type I- Idiopathic/Primary
Term
What is the signalment for idiopathic IMPA?
Definition
middle aged large breed dogs (1-4 yo)
Term
what % of dogs with idiopathic IMPA have lameness/gait abnormalities? and what amount of these involve single vs multiple limbs?
Definition
60% lameness gait abnormalities

60% multiple limbs
20% single limbs
20% shifting limbs
Term
what region of the limbs are most commonly affected by idiopathic IMPA?
Definition
distal limbs and stifle
Term
what are the clinical signs commonly assoc w/ idiopathic IMPA?
Definition
lameness/gait abnormalities, inability to rise, fever, exam-joint pain and/or swelling
Term
what clinical sign of idiopathic IMPA is a common cause of referral
Definition
Fever with unknown cause
Term
T/F: you CAN distinguish idiopathic IMPA on clinical presentation alone
Definition
False: You CAN NOT distinguish idiopathic IMPA on clinical presentation alone.
Term
Describe the clinical presentation of patients with idiopathic IMPA
Definition
primary complaint of chronic lameness w/ or w/out other systemic signs

lameness may be cyclic, monoarticular, or polyarticular

joint distension, soft tissue swelling
Term
what is the cause of the clinical signs in idiopathic IMPA?
Definition
immune complex deposition and hypersensitivity rxns are cause of clinical signs
Term
How do you diagnose idiopathic IMPA
Definition
clinical signs
Minimum database (CBC, Chem, UA)
Radiographs
Histopath (not routinely performed)
Term
what fraction of patients would the minimum database be useful for? and unuseful for?
Definition
useful for 1/3 of patients (that dont have type I IMPA)

unuseful for the 2/3 of patients with primary IMPA
Term
What may a CBC indicate for patients with:
primary IMPA
SLE/tick-borne dz
infectious IMPA (type II)
Definition
Primary IMPA: non-specific leukocytosis, mild anemia, CBC may be normal

SLE/tick-borne dz: cytopenias

Infectious: evaluate for organisms/ inclusions
Term
What might you see on xray in a patient with IMPA?
Definition
fluid in the joint-> decreased opacity of the fat pad

fuzzy soft tissue density surrounding the joint

[if Rheumatiod arthritis -> may see bone loss]
Term
What tissue sample(s) would you take for histopath? and what might you see?
Definition
Synovial membrane biopsy:
- inflamm. infiltrate of
lymphocytes, plasma cells,
macrophages, neutrophils
- fibrin deposits presents,
vasculitis
- infiltrate of lymphocytes, plasma
cells

Muscle biopsy: (polyarthritis/polymyositis)
- myositis-mononuclear cell and
neurophilic infiltrate & necrosis
Term
How would you diagnose secondary IMPA
type II
misc.
Type III
Type IV
Definition
PE, history, clinical signs, clinico-pathologic findings

chronic infectious dz:
- sterile arthritis with a positive
culture of infectious foci
elsewhere in the boby (eg.
urinary, resp, bacterial
endocarditis, discospondylitis)
drug induced:
-suspected if use of ANY drug,
vaccinations
Plasmacytic-lymphocytic synovitis:
-freq Dx at surgical repair for
ruptured cranial cruciate
ligament
enteric/hepatic/neoplastic:
-usu found in assoc w/ thorough
work up
Term
What kind of patient prep is needed for arthrocentesis?
Definition
sedation
aseptic technique
Term
T/F:

only a single joint needs to be sampled in arthrocentesis
Definition
False: sample multiple (3-6) joints
Term
What 2 joints are easiest to tap for arthrocentesis?
Definition
carpal & stifle
Term
which joints have a higher diagnostic yeild for arthrocetesis?
Definition
tarsal/hock joints
-include at least 1 hock joint sample
Term
What kind of diagnostic tests can you perform with synovial fluid?
Definition
direct smear
cell counts
bacterial cultures
Term
T/F: it is easy to see landmarks for arthrocentesis with joint effusion
Definition
false
Term
Does visocity of the synovial fluid increase or decrease with inflammation
Definition
decreases
Term
What diagnostic test is essential to differentiate between inflammatory and noninflammatory joint diease?*
Definition
synovial fluid analysis!
Term
What will the synovial fluid look like in an inflammatory joint disease?
Definition
-increased volume of synovial fluid
-fluid discoloration
-decreased viscosity
-fluid may clot when exposed to air due to increased fibrinogen
-bacterial and Mycoplasma cultures megative
Term
**What is the predominant cell type seen in synovial fluid anlysis for inflammatory joint disease?

what does the cell count look like?
Definition
**Nondegenerate Neutrophils**

markedly increased nucleated cells (3000-100,000)
Term
What is an ANA test and what is the typical outcome of this test for IMPA?
Definition
ANA= anti-nuclear antibody test

usu. negative or low titer
Term
What is a diagnostic test for IMPA if you were concerned about a tick borne disease
Definition
Serology
- positive from exposure
- acute and convalescent titers are
recommended for cases that you
suspect have tick borne dz
Term
How would you treat primary IMPA?
Definition
Immunosuppressants
- Prednisone
- repeat arthrocentesis-minimal risk
(2-3 wk intervals to guide therapy)
- When to add ancillary therapy?
- refractory patients at 2wks
or relapsed patients
- Azothiaprine, cyclosporine,
leflunomide
-also, scree for underlying
causes
Term
What is the prognosis of primary/idiopathic IMPA?
Definition
>55% can be tapered off immunosuppressants

20% managed with long term meds

15% refractory to initial trx

recurrence 10%
Term
How would you trx secondary IMPA?
(immunosuppressants, ricketsial, drug/vaccine)
Definition
Immunosuppressants?
-w/detection & trx of the
underlying cause these aren't
needed
Rickettsial
-A.phagocytophila & B.burgdorferi
*Doxycycline
-Short tern NSAIDs
Drug/vaccine induced
-resolve shortly after detection...
short term NSAIDs
Term
how would you trx secondary IMPA?
(SLE, neoplasia)
Definition
SLE:
- challenging to definitively Dx
- long term immunosuppression needed
- Px- guarded
Distant neoplasia
- ID & elimination if possible
- Lymphoma/osteosarcoma/hemangiosarc
Term
List some important "Do's" for Dx and Trx of IMPA
Definition
-Attempt to detect underlying dz to determine Px and guide trx
-allow Hx & exam to guide testing
(recent drugs/vaccines, heart murmur-
bacterial endocarditis, skin/oral
lesions-SLE)
-allow your CBC/chem/UA to guide additional testing
-thrombocytopenia or anemia
(rickettsial dz, SLE)
-liver enzyme elevation/
hypoalbuminemia- Liver/GI assoc.
IMPA
-azotemia/proteinuria - Rickettsial
dz/SLE
-bacteruria- infxn assoc. IMPA
-allow response to therapy and repeat arthrocentesis guide trx
-Px: good...most dogs will respond...
-consider additional testing in those that do not respond/relapse
-repeat joint imaging/arthrocentesis
-additional screening for cancer
-look for the "red herring"
(Bartonella, RMSF, E.canis)
Term
List some important "DON'Ts" for IMPA Dx and Trx
Definition
-do not assume that all cases of IMPA are idiopathic
-do not over-interpret ancillary tests
-SLE requires more than positive
ANA test
-RA requires more than positive RF
-Lyme/anaplasma exposure may not
be causing dz
Term
What is the prognosis for primary IMPA?
Definition
Good!
Term
What is the prognosis for secondary IMPA?
Definition
depends on underlying cause
-rickettsial dz: excellent
-drug/vaccine related: excellent
-neoplasia: poor
Term
What is an example of an erosive arthropathy?
Definition
Rheumatoid Arthritis
Term
What is erosive arthritis/ Rheumatoid arthritis (RA)?
Definition
chronic, progressive inflammatory joint disease characterized by erosive and destructive changes within the joints

(also: feline chronic progressive polyarthritis)
Term
What is the etiology of RA?
Definition
cause is unknown, but is classified as an immune mediated disease

cellular and hypersensitivity rxns present (types II, III, IV)

Synovitis likely due to immune complex rxns with Ag, Ab, rheumatiod factor (RF), and complement
- RFs are compsed of anti-IgG Ab
- RFs activate complement cascade->
stimulate release of PGEs-> cause
inflammation
Term
What is the typical clinical presentation of patients with RA?
Definition
small and medium breeds

middle aged dogs (4-7yo)

Greyhounds and Shelties predisposed

initial signs parallel IMPA (joint pain, effusion, soft tissue swelling, decreased range of motion)

often episodic w/ increasing frequency and duration w/each relapse

signs of systemic illness (fever, lymphadenopathy, anorexia)
Term
k
Definition
Term
Which joints are most commonly affected by RA?
Definition
carpal, tarsal, interphalangeal joints
Term
What Dx tests would you perform for RA? and what would the results look like?
Definition
PE, Hx, clinical signs, clinico-pathologic and radiographic findings

CBC/Chem/UA:
similar to nonerosive arthritis/IMPA
Synovial Fluid Analysis:
nucleated cell count moderately to
markedly increased(3000-100,000)
predominant cells are degernerate
neutrophils
cultures negative
like IMPA: increased volume of
synovial fluid, fluid discoloration
& decreased viscosity
RF serolgy:
positive in 25-70% of dogs (positive
titers found in dogs with chronic
infxns and 5% of normal dogs...not
very helpful)
ANA test
variably positive(freq non-specific)
Radiographs
-joint capsule distension,
periarticular swelling, bony
erosions or loss of trabecular bone
density in epiphyses
-may not see erosions early in dz
-Lesions are progressive, leads to
2nd degen joint dz**
Histopath
-synovitis w/synovial cell
hyperplasia, villus atrophy, fibrin
deposition, marked inflammatory
infiltrate of lymphocytes and
plasma cell macrophages
-granulation tissue can arise from
synovium
Term
Contrast the predominant cell types in RA and IMPA.
Definition
RA: degenerate neutrophils
IMPA: nondegenerate neutrophils
Term
How might you diagnose RA based on the American Rheumatoid Association data?
Definition
- stiffness after rest
- pain/tenderness in at least 1 joint
- swelling in at least 1 joint
- swelling of at least 1 other joint in
3 months
- symmetrical joint swelling
- SQ nodules over bony prominences or
extensor surfaces or in juxta-
articular regions
- **destructive xray changes typical
- **positive agglutination test for
serum RF
-poor mucin precip from synovial fluid
- **characteristic histopath changes in
the synovial membrane

*at least 2 **criteria should be met for RA
Term
How would you trx RA?
Definition
-No specific therapy
-pain management
-corticosteroids at anti-inflammatory or immunosuppressive doses (usu. become refractory)

-combo immunosuppressive therapy may slow progression **
Term
what is the prognosis of RA?
Definition
Poor!!

most animals euthanized due to chronic pain from degenerativ joint dz
Term
Which has a worse prognosis, IMPA or RA
Definition
RA (poor)!

[IMPA good]
Term
What breeds are predisposed to IMPA?
Definition
german shepherd, doberman pinscher, lab, golden retreiver, irish setter
Term
What are dog erythrocyte antigens?
Definition
cell membrane receptors on RBCs
Term
how many blood groups do dogs have?
Definition
8
Term
Most dogs are positive for which dog erythrocyte antigen (DEA)?
Definition
DEA 4
Term
do anti-DEA 4 antibodies cause hemolysis?
Definition
no
Term
What is a canine universal donor?
Definition
Positive for DEA 4

Negative for DEA 1,2,3,5,6,7,8 (all except 4)
Term
How many blood types do cats have? what are they?
Definition
3

type A, B, AB

(also MLK- mike the cat has his own blood type)
Term
What is the universal donor for cats?
Definition
there is NONE
Term
type B cats have HIGH levels of what kind of Ab's?
Definition
anti-A Ab's

**so NEVER give type A to type B (type B students hate type A students)
Term
type AB cats have antibiodies against which blood types?
Definition
neither type A or type B
Term
what 2 conditoins would you see high levels of Abs against type A RBCs?
Definition
severe/fatal transfusion rxn (ie-give type A blood to type B cat)

neonatal isoerythrolysis
Term
How long will RBCs last in the following situations:

1)type A cat gets type A blood
2)type A blood given to type B cat
Definition
1)30days

2)1-3hrs
Term
How many blood types in horses?

Universal donors for horses are negative for which Abs?
Definition
7

Aa, Aq
Term
Which blood groups have the greatest significance in bovine?
Definition
B and J
Term
What are the indications for a transfusion?
Definition
Anemia
Coagulopathies
Hypoalbuminemia
Thrombocytopenia (ie- ITP)
Term
Which breed is often a good blood donor? why?
Definition
Greyhounds!

can really see their veins
PCV normally runs higher
Term
How do you select a canine donor
Definition
>25kg
normal/healthy
CBC/Chem/UA/fecal
Negative for: HW, Lyme dz, babesia,
rickettsial dz
DEA 1, 2, 7 negative
Term
What do you want in a feline donor?
Definition
>4.5kg
indoor only
normal/healthy;males (healthier weight)
CBC/Chem/UA/fecal
blood type
negative for:FeLV/FIV,toxoplasma gondii
Term
what step do you add to feline blood collection steps/techniques/procedure?
Definition
Sedation (ketamine/midazolam)
Term
How much packed RBCs do you get from one unit of fresh whole blood (450mL)?
Definition
250mL
Term
What is the purpose of a crossmatch?
Definition
detect presence of antibodies against RBCs
-incompatabilities/preventing
transfusion rxns
Term
For a crossmatch what blood component is the Ab vs the Ag? (serum or RBCs)
Definition
Serum= Ab
RBCs= Ag
Term
What is the *Major crossmatch?
Definition
-Patient serum (Ab)
-Donor RBCs (Ag)

*if problem here, do NOT give donor RBCs to the patient
Term
What is the Minor crossmatch?
Definition
Donor serum (Ab)
Patient RBCs (Ag)

(not like real life as in a transfusion the patient is getting donor RBCs)
Term
what do you look for when evaluating a crossmatch result?
Definition
Macroscopically:
hemolysis
agglutination/clumping
-cells should fall freely from the
pellet
-differentiate rouleaux vs agglutin.

Microscopically:
agglutination
(rouleaux will disperse with a drop
of saline)
hemolysis
Term
If you are in an emergency situation and unable to crossmatch (or you suspect IMHA) what should you do to choose a donor?
Definition
Blood type
Term
WHat clinical signs indicate anemia and that the patient may need a transfusion
Definition
tachycardia, tachypnea, dyspnea, depression, PCV< 12-15%
Term
How much blood do you need?
Definition
1mL per pound raises the PCV by 1%
Term
What is the max length of time for giving a transfusion? why?
Definition
4-6 hrs

risk of bacterial infection
Term
How much type A blood can result in death in a type B cat?
Definition
1mL
Term
List some signs of transfusion complications/ reactions
Definition
Immunologic
- fever, hemolysis, acute
hypersensitivity, platelet and
leukocyte sensitivity,
immunosuppression
Non-immunologic
-circulatory overload, bacterial
contamination, transmission of
infectious diseases, citrate
toxicity (hypocalcemia), pulmonary
microembolism
Term
when should you STOP a transfusion
Definition
body temp raises one degree higher than pre-transfusion temp

tachycardia, tachypnea, vomiting develops
Term
when should you STOP a transfusion
Definition
body temp raises one degree higher than pre-transfusion temp

tachycardia, tachypnea, vomiting develops
Term
how would you treat a transfusion rxn?
Definition
IV catheter & crystalloids
monitor BP (colloids if low)
administer diphenhydramine
administer: dexmethasone sodium phosphate & epinephrine for anaphylactic shock; pred acetate for urticaria (wheals)
Term
what are the indications and contraindications for an autologous blood transfusion
Definition
indications: preoperative donation
salvage procedure in cavitary bleeding

contraindications: bacterial contamination, neoplasia?
Term
What are some complications of autotransfusions?
Definition
citrate toxicity (hypocalcemia)
-manifests as weakness, seizures
bacterial contamination
iatrogenic metastasis
Term
how many blood groups do avians have?
Definition
28
Term
what infectious disease should you screen for in an avian donor?
Definition
psittacosis
Term
how much blood can an avian donor give?
Definition
10% blood volume (blood vol is ~10%BW)

(ie- 500g parrot can give 5mL blood)
Term
what two methods can be used to administer an avian transfusion?
Definition
IV and intraosseous
Term
What is unique about ferret blood types?
Definition
there are none

so crossmatch NOT needed
Term
what are the pros and cons of using oxyglobin?
Definition
pros:
no crossmatch
long shelf life
no immune rxns

cons:
interferes w/lab tests
colloidal osmotic pressure increased
t1/2 in dogs = 1-2days
IMHA?
Term
what does oxyglobin do?
Definition
increases free HgB
Term
how do you monitor oxyglobin efficacy?
Definition
monitor HgB

estimate PCV by multiplying HgB x 3
Term
what are the indications for use of hetastarch
Definition
hypotension
hypoproteinemia
hypoalbuminemia
Term
what effect will heastarch have on albumin levels?
Definition
none
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