Approach to anaemia 2 Flashcards by Olivia Jones

What are the 3 main methods of treatment for IMHA?

Treat underlying disease
Immunosuppression (in some cases)
Supportive therapy

How well did you know this?

Not at all

Perfectly

Is immunotherapy required for primary or secondary IMHA?

Primary

Sometimes secondary

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

What supportive therapies may be given for IMHA?

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

How well did you know this?

Not at all

Perfectly

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

No - requires RBCs to carry the oxygen

May help if pulmonary thromboembolism

How well did you know this?

Not at all

Perfectly

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

Maintains renal and hepatic perfusion

Especially important if intravascular haemolysis

How well did you know this?

Not at all

Perfectly

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

Careful not to overload volume

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

How well did you know this?

Not at all

Perfectly

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

Thromboembolisms

How well did you know this?

Not at all

Perfectly

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

Aspirin and clopidogrel - reduce platelet activation

Heparin and low molecular weight heparin - reduce XS coagulation cascade

How well did you know this?

Not at all

Perfectly

Why are blood transfusions controversial for treating IMHA?

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

Emergencies
Anorexic patients

PUPD, GI signs, long term use damage organs

How well did you know this?

Not at all

Perfectly

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?

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

How well did you know this?

Not at all

Perfectly

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?

Not suitable for cats

Use mycophenolate mofetil

How well did you know this?

Not at all

Perfectly

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

Splenectomy

Make sure not infected with vector borne diseases - worsens condition

How well did you know this?

Not at all

Perfectly

What is neonatal isoerythrolysis?

Specific type of IMHA

Neonatal RBCs destroyed by maternal antibodies

How well did you know this?

Not at all

Perfectly

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

If mother has different blood type to puppies

Maternal antibodies destroy neonatal RBCs

How well did you know this?

Not at all

Perfectly

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

Type A or AB kittens

Born to a B queen

How well did you know this?

Not at all

Perfectly

What breed of cat is prone to neonatal isoerythrolysis?

British shorthair

How well did you know this?

Not at all

Perfectly

Can you give a cat any blood type?

Never give a type B cat type A blood

How well did you know this?

Not at all

Perfectly

How can the risk of neonatal isoerythrolysis be reduced?

Avoid mating B queens with A/AB toms

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

How well did you know this?

Not at all

Perfectly

Mycoplasmosis causes what type of anaemia?

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

How well did you know this?

Not at all

Perfectly

What organism causes mycoplasmosis in cats

Mycoplasma haemofelis

How well did you know this?

Not at all

Perfectly

How can mycoplasmosis in cats be diagnosed?

PCR

How well did you know this?

Not at all

Perfectly

Can a cat be treated for mycoplasmosis?

Treatment with doxycycline or prednisolone BUT | Once infected infected for life

What is microangiopathic haemolytic anaemia?

Type of anaemia caused by mechanical damage to RBCs

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

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

What RBC abnormalities are found with microangiopathic haemolytic?

Shistocytes | Acanthocytes

What is intrinsic haemolytic anaemia?

Rare inherited metabolic defects | Leads to RBC membrane instability and defects

What are shistocytes?

Fragments of RBCs

What conditions are associated with shistocytes?

``` Microangiopathic haemolytic anaemia and their causes DIC Glomerulonephritis Neoplasia Vascular anomalies/congenital defects ```

What are acanthocytes?

RBCs with unevenly spaced projections (vary in length)

What conditions are associated with acanthocytes?

``` Microangiopathic haemolytic aanaemia Liver disease Lymphoma Spleen disorders High cholesterol diets and cholesterol metabolism abnormalities ```

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

Acanthocytes

What are Heinz bodies? What are they aggregates of?

Round, pale inclusion on surface of RBC membrane | Denatured haemoglobin

What causes Heinz body anaemia?

``` Oxidative damage (Extravascular or intravascular haemolysis) ```

What stain highlights Heinz bodies?

New Methylene blue

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

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

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

Remove what is causing the oxidation | Supportive care

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

Non-Regenerative anaemia has absence of reticulocytes

What are some examples of non-regenerative anaemia?

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

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

Bone marrow sample

Intramarrow disease has many causes. Give some examples of these

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

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

``` Exogenous oestrogen (drugs) Endogenous oestrogen e.g. Sertoli cell tumours ```

What are the symptoms/clinical findings of oestrogen toxicity?

``` Tumours Intramarrow disease Pancytopenia Thrombocytopenia Neutrophilia then neutropenia Anaemia ```

How is oestrogen toxicity treated?

Antibiotics Transfusions Remove neoplasms

What is the prognosis for oestrogen toxicity?

Very poor - majority die

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

No erythroid precursors in the bone marrow | Immune mediated

What is the treatment for pure red cell aplasia?

Remove cause Transfusions Immunosuppressive therapy

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

All blood cells affected | Supportive

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

Proliferation of collagen and reticulin fibres in the bone marrow

What causes myelofibrosis - is it primary or secondary?

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

What is the treatment for myelofibrosis?

Transfusion Immunosuppression Anabolic steroids

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

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

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

Decreased erythropoietin production | Leads to reduced RBC survival, reduced erythropoiesis and haemorrhage

What is the treatment for anaemia of chronic kidney disease?

Increased erythropoietin concentration | Minimise blood loss

Give examples of 2 feline retroviruses that can cause anaemia

FeLV | FIV

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

Non-regenerative anaemia

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

``` Red cell aplasia Aplastic anaemia Anaemia of chronic disease Myelodysplasia Acute leukaemia ```

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

Granulocytes | Eosinophil, basophil, neutrophil

Approach to anaemia 2 Flashcards

(60 cards)