32. haemolytic anemia. babesia

Question 1

what is haemolytic anemia, and what types do we have

Answer 1

regenerative anemia RI>2,5
increased destruction of RBC
congenital
aquired

Question 2

what are the congenital forms of hemolytic anemia

Answer 2

pyruvate kinase deficiency - beagle

phosphofruktokinase deficiency - spaniels

Question 3

what are the aquired forms of hemolytic anemia

Answer 3

chemicals - lead, onion 
immune mediated hemolytic anemia 
drugs - paracetamol 
bacteria - staph, strep 
parasite - babesia

Question 4

what are the clinical signs of hemolytic anemia

Answer 4

lethargy, fever
anemia, icterus - lemon yellow!!
splenomegaly, hepatomegaly - erythrocyte destruction
hemoglobinuria, bilirubinuria

Question 5

how can we diagnose hemolytic anemia

Answer 5

TP increased
TBr increased
prerenal azotaemia
haemoculture - pathogens

Question 6

immune mediated hemolytic anemia - pathogenesis

Answer 6

cytotoxic reaction against erythrocyte
happens because surface of RBC is altered
antibody or complement reaction
- intravascular cytolysis by complement
- phagocytosis in spleen or liver - extravascular hemolysis
(don’t always phagocyte whole rbc - spherocytes in blood -> CLUE IF IMHA)

Question 7

classification of IMHA

Answer 7

primary - idiopathic 60-70%
secondary 
- babesia, mycoplasma, dirofilaria 
- drugs 
- vaccines

Question 8

typical imha clinical signs

Answer 8

cold agglutinin disease: necrosis of ear margin, tail, toes

Question 9

diagnosis of IMHA

Answer 9

SPHEROCYTOSIS, ANISOCYTOSIS
increased bilirubin
autoagglutination

Question 10

treatment of IMHA

Answer 10

prednisolone (+ cimetidine - gi protect)
cyclosporine if gcc is not enough
heparin if auto agglutination is severe
in severe case: blood transfusion BUT use correct blood type

Question 11

what is babesiosis

Answer 11

babesia canis, b. vogeli, b rossi

tick vector - dermacentor

Question 12

clinical signs of babesia

Answer 12

acute: fever, splenomegaly, hemoglobinuria
chronic: anemia and or icterus

Question 13

diagnosis of babesia

Answer 13

blood smear, giemsa: detect infected erythrocytes 
PCR, serology 
thrombocytopenia 
low platelets, PCV
ALT increase, creatinine increase
icterus and hemoglobinuria

Question 14

babesia can damage multiple organs

Answer 14

systemic inflammatory response syndrome - SIRS
shock, anemia, damaged Hb ->tissue hypoxia
-> release inflammatory mediators (cytokine, free radicals)
-> inflammation and dysfuntion of organs

Question 15

therapy of babesia

Answer 15

imidocarb
fluid therapy
diuretics
gcc