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Haematology (MOD) > Approach to anaemia 2 > Flashcards

Approach to anaemia 2 Flashcards

1
Q

What are the 3 main methods of treatment for IMHA?

A

Treat underlying disease
Immunosuppression (in some cases)
Supportive therapy

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2
Q

Is immunotherapy required for primary or secondary IMHA?

A

Primary

Sometimes secondary

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3
Q

Should the dose of immunosuppression be high or low for treating IMHA?

A

Start high and gradually reduce
2 weeks between each reduction
(May be taking for months, or up to life)

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4
Q

What supportive therapies may be given for IMHA?

A

Oxygen
Fluids
Drugs that reduce platelet activation and the coagulation cascade
Blood transfusion

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5
Q

Does oxygen have much benefit as a supportive treatment for IMHA? Why?

A

No - requires RBCs to carry the oxygen

May help if pulmonary thromboembolism

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6
Q

Why is fluid therapy an important aspect of IMHA supportive treatment?

A

Maintains renal and hepatic perfusion

Especially important if intravascular haemolysis

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7
Q

What should you be careful with when using IVFT for supportive IMHA treatment?

A

Careful not to overload volume

Patients aren’t usually hypovolaemic - just aiming to dilute the haem in blood

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8
Q

What is a serious complication of IMHA? (think due to agglutination)

A

Thromboembolisms

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9
Q

How can the risk of thromboembolisms (with IMHA) be reduced?

A

Aspirin and clopidogrel - reduce platelet activation

Heparin and low molecular weight heparin - reduce XS coagulation cascade

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10
Q

Why are blood transfusions controversial for treating IMHA?

A

May cause even more increased RBC destruction
Risk of pulmonary thromboembolism
Transfused RBCs have short lifespan

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11
Q

Give examples of drugs that may be used to treat idiopathic/primary IMHA

A

Corticosteroids - prednisolone, dexmethasone
Cytotoxics - azathioprine (dogs), mycophenolate mofetil (cats)
Cyclosporin

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12
Q

When might corticosteroids (prednisolone, dexamethasone) be used to treat IMHA? What are side effects?

A

Emergencies
Anorexic patients

PUPD, GI signs, long term use damage organs

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13
Q

Azathioprine is a cytotoxic drug that is the drug of choice to treat IMHA in dogs. Would you use it alone? What are the side effects?

A

Delayed onset of action -use in combination with prednisolone
Myelodepression, GI effects

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14
Q

Azathioprine is a cytotoxic drug that is the drug of choice to treat IMHA in dogs. Can it be used in cats? What should be given?

A

Not suitable for cats

Use mycophenolate mofetil

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15
Q

What surgical treatment may be considered for treating idiopathic/primary IMHA?

A

Splenectomy

Make sure not infected with vector borne diseases - worsens condition

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16
Q

What is neonatal isoerythrolysis?

A

Specific type of IMHA

Neonatal RBCs destroyed by maternal antibodies

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17
Q

Neonatal isoerythrolysis is rare in puppies and kittens. What can cause it?

A

If mother has different blood type to puppies

Maternal antibodies destroy neonatal RBCs

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18
Q

Neonatal isoerythrolysis can occur in kittens with what blood type? What is the mothers blood type?

A

Type A or AB kittens

Born to a B queen

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19
Q

What breed of cat is prone to neonatal isoerythrolysis?

A

British shorthair

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20
Q

Can you give a cat any blood type?

A

NO

Never give a type B cat type A blood

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21
Q

How can the risk of neonatal isoerythrolysis be reduced?

A

Avoid mating B queens with A/AB toms

Foster kittens for first 24 hrs - give milk from queen with same blood type

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22
Q

Mycoplasmosis causes what type of anaemia?

A 
Regenerative anaemia (non-regenerative if associated with FeLV/FIV)
Due to haemolysis (mostly IMHA)
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23
Q

What organism causes mycoplasmosis in cats

A

Mycoplasma haemofelis

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24
Q

How can mycoplasmosis in cats be diagnosed?

A

PCR

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25
Q

Can a cat be treated for mycoplasmosis?

A

Treatment with doxycycline or prednisolone BUT

Once infected infected for life

26
Q

What is microangiopathic haemolytic anaemia?

A

Type of anaemia caused by mechanical damage to RBCs

27
Q

Microangiopathic haemolytic anaemia is due to mechanical damage of RBCs. What may cause this?

A

Altered vasculature e.g. haemangiosarcoma
Fibrin nets (DIC)
Glomerulonephritis
Vascular anomalies/congenital heart defects

28
Q

What RBC abnormalities are found with microangiopathic haemolytic?

A

Shistocytes

Acanthocytes

29
Q

What is intrinsic haemolytic anaemia?

A

Rare inherited metabolic defects

Leads to RBC membrane instability and defects

30
Q

What are shistocytes?

A

Fragments of RBCs

31
Q

What conditions are associated with shistocytes?

A 
Microangiopathic haemolytic anaemia and their causes
DIC
Glomerulonephritis 
Neoplasia
Vascular anomalies/congenital defects
32
Q

What are acanthocytes?

A

RBCs with unevenly spaced projections (vary in length)

33
Q

What conditions are associated with acanthocytes?

A 
Microangiopathic haemolytic aanaemia
Liver disease
Lymphoma
Spleen disorders
High cholesterol diets and cholesterol metabolism abnormalities
34
Q

Which RBC abnormality can be associated with cholesterol metabolism and high cholesterol diets?

A

Acanthocytes

35
Q

What are Heinz bodies? What are they aggregates of?

A

Round, pale inclusion on surface of RBC membrane

Denatured haemoglobin

36
Q

What causes Heinz body anaemia?

A 
Oxidative damage 
(Extravascular or intravascular haemolysis)
37
Q

What stain highlights Heinz bodies?

A

New Methylene blue

38
Q

What can oxidative injury result in (in terms of haematology)?

A

Non immediate cell destruction:
Methaemoglobinaemia
Heinz body formation
RBC membrane oxidation - fragile membrane - phagocytose by macrophages

39
Q

Oxidative injury causes non-immune mediated RBC destruction. What is the treatment for this?

A

Remove what is causing the oxidation

Supportive care

40
Q

How can non-regenerative anaemia be distinguished from regenerative anaemia on a blood smear?

A

Non-Regenerative anaemia has absence of reticulocytes

41
Q

What are some examples of non-regenerative anaemia?

A

Primary bone marrow disease
Lack of erythropoietin (due to kidney disease)
Other diseases affecting bone marrow function

42
Q

Intramarrow disease causes a type of non-regenerative anaemia. How is it diagnosed?

A

Bone marrow sample

43
Q

Intramarrow disease has many causes. Give some examples of these

A 
Idiosyncratic drug reactions (many drugs)
Oetrogen toxicity
Pure red cell aplasia
Aplastic anaemia
Myelofibrosis
Myelodisplastic syndromes
44
Q

Intramarrow disease can be due to oestrogen toxicity. Give examples of what can cause oestrogen toxicity

A 
Exogenous oestrogen (drugs) 
Endogenous oestrogen e.g. Sertoli cell tumours
45
Q

What are the symptoms/clinical findings of oestrogen toxicity?

A 
Tumours 
Intramarrow disease
Pancytopenia
Thrombocytopenia
Neutrophilia then neutropenia 
Anaemia
46
Q

How is oestrogen toxicity treated?

A

Antibiotics
Transfusions
Remove neoplasms

47
Q

What is the prognosis for oestrogen toxicity?

A

Very poor - majority die

48
Q

Intra marrow disease can be due to pure red cell aplasia. What is this and what is likely to cause it?

A

No erythroid precursors in the bone marrow

Immune mediated

49
Q

What is the treatment for pure red cell aplasia?

A

Remove cause
Transfusions
Immunosuppressive therapy

50
Q

Intra marrow disease can be due to aplastic anaemia. Which cells are affected? what is the treatment?

A

All blood cells affected

Supportive

51
Q

Intramarrow disease can be due to myelofibrosis. What is myelofibrosis?

A

Proliferation of collagen and reticulin fibres in the bone marrow

52
Q

What causes myelofibrosis - is it primary or secondary?

A

Secondary to damage of marrow stroma, retroviral infections, can be idiopathic

53
Q

What is the treatment for myelofibrosis?

A

Transfusion
Immunosuppression
Anabolic steroids

54
Q

Anaemia of chronic disease is a common disease AKA anaemia of chronic inflammation. What type of anaemia does this cause?

A 
Normocytic 
Normochromic
Non-regenerative anaemia
Usually mild
(No specific therapy - resolve underlying disease)
55
Q

Anaemia of chronic disease causes normocytic, normochromic, non-regenerative anaemia. What causes this disease?

A

Decreased erythropoietin production

Leads to reduced RBC survival, reduced erythropoiesis and haemorrhage

56
Q

What is the treatment for anaemia of chronic kidney disease?

A

Increased erythropoietin concentration

Minimise blood loss

57
Q

Give examples of 2 feline retroviruses that can cause anaemia

A

FeLV

FIV

58
Q

What type of anaemia do FeLV and FIV usually cause - regenerative or not?

A

Non-regenerative anaemia

59
Q

FeLV can occasionally cause macrocytic anaemia. What are some of the mechanisms in which FeLV can cause anaemia?

A 
Red cell aplasia
Aplastic anaemia
Anaemia of chronic disease
Myelodysplasia
Acute leukaemia
60
Q

FIV causes non-regenerative anaemia. Which blood cells are usually more affected?

A

Granulocytes

Eosinophil, basophil, neutrophil

Haematology (MOD) (7 decks)

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