Approach to anaemia 2 Flashcards
What is the overall role of treatment for IMHA?
Immunosuppressive therapy
Which drugs is used for first line immunosuppressive therapy?
Prednisolone - Oral
If an animal is inappetent and wont take prednisolone orally which drug can be used instead?
Dexamethasone - IV
Give examples of other immunosuppressive drugs
- Azathioprine
- Ciclosporin
- Leflunomide
Which immunosuppressive drugs is toxic to cats?
Azathioprine
Give some side effects related to prednisolone
- Polyuria, polydipsia, polyphagia
- GI toxicity
- Muscle wastage
How can you decide if it is necessary to use a second immunosuppressive treatment?
- Clinical features of severe /life threatening disease
- No response to corticosteroids over first 7d
- Patient with or at risk of severe corticosteroid side effects
Describe dosing and length of treatment for IMHA
- Start ‘high’ and gradually reduce doses if anaemia under control
- Minimum 2-3 weeks between dose reductions
- Prednisolone treatments lasts 3-6 months
- Some animals may relapse and be on treatment for life
How do immunoglobulins work as an immunosuppressive treatment?
Block Fc receptor of macrophages and bind/block circulating antibodies
Immune mediated haemolytic anaemia leads to a high risk of what disease?
Thromboembolic disease
Which drugs would be used for:
- primary haemostasis?
- secondary haemostasis?
- Antiplatelet drug e.g. Clopidogrel
- Anticoagulant e.g. unfractionate heparin
Describe neonatal isoerythrolysis in a dogs
- Very rare but can occur in puppies
- Destruction of neonates RBCs by maternal antibodies
- DEA1.1 positive puppies affected
Describe neonatal isoerythrolysis in a cat
- Rare
- Type A or AB kitten born to a type B queen
- British shorthairs
What is microangiopathic haemolytic anaemia?
- RBCs are mechanically damaged or fragmented as they pass through fibrin mesh works in the microvasculature
What could be the possible underlying causes of microangiopathic haemeolytic anaemia
- Altered vasculature e.g. haemangiosarcoma
- Fibrin nets - DIC
- Glomerulonephritis
What is the name given to fragmented RBCs?
Schistocytes
A RBC with multiple, rounded projections of variable length is a ?
Acanthocyte
What are the causes of acanthocytes?
- Liver disease
- Lymphoma
- Glomerulonephritis
- Cholesterol metabolism abnormalities
What can cause oxidative injury to RBCs in:
- dogs
- cats
- Onions, zinc
- Paracetamol
Oxidative injury results in … ?
- Heinz body formation
- RBC membrane oxidation (eccentrocytes)
What are Heinz bodies?
Clumps of damaged haemoglobin attached to your red blood cells
Which stain highlights Heinz bodies?
New Methylene blue
Give some examples of blood parasites
- Mycoplasma haemofelis
- Babesia canis
- Ehrlichia
What type of anaemia is caused by Mycoplasma haemofelis?
- Regenerative anaemia
- Immune mediated haemolysis
Mycoplasma haemofelis usually only causes anaemia in dogs which have undergone which surgical treatment?
Splenectomy
How can mycoplasma haemofelis be diagnosed?
PCR
- once infected, always infected
Non-regenerative anaemia has the absence of which cells?
Reticulocytes
What are the causes of non-regenerative anaemia?
- Primary marrow disease
- Lack of erythropoietin (e.g. due to kidney disease)
What are some causes of intramarrow disease?
- idiosyncratic drug reactions
- Oestrogen toxicity
- Pure red cell aplasia
- Myelofibrosis
What is an idiosyncratic drug reaction?
Unpredictable, individual adverse reaction to a drug
What is myelofibrosis?
Proliferation of collagen and reticulin fibres in bone marrow
Describe the features of anaemia of chronic disease
- very common
- normocytic, normochromic
- non-regenerative
Does anaemia of chronic disease require treatment?
Doesn’t require specific therapy - it should resolve once the underlying disease is cured
Why does chronic kidney disease cause anaemia?
Reduced erythropoietin production => reduced erythropoiesis
Which 2 feline retroviruses can cause non-regenerative anaemia?
Feline immunodeficiency virus (FIV)
Feline Leukaemia virus (FeLV)
