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SA DX & TX I > Exam 3 - IMHA Diagnosis & Therapy > Flashcards

Exam 3 - IMHA Diagnosis & Therapy Flashcards

1
Q

which is worse: intravascular hemolytic anemia or extravascular hemolytic anemia?

A

intravascular

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2
Q

what is the mechanism associated with intravascular hemolytic anemia?

A

rupture within the blood vessel – IgM associated

can happen from toxins, not just immune

hemoglobin released in blood & urine

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3
Q

what is the mechanism associated with extravascular hemolytic anemia?

A

destruction of RBC by macrophages in spleen or liver – usually IgG

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4
Q

what lab abnormalities are associated with intravascular hemolytic anemia?

A

hemoglobinemia, hemoglobinuria, pigmenturia, & red serum

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5
Q

what lab abnormalities are associated with extravascular hemolytic anemia?

A

hyperbilirubinemia, hyperbilirubinuria, pigmenturia, & yellow serum

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6
Q

what are the main differences between the causes of primary & secondary hemolytic anemia?

A

primary – synonymous with idiopathic, underlying cause not found

secondary – identifiable underlying trigger such as: antibiotics, vaccination, infectious, parasites, must rule out toxins such as zinc & penny ingestion

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7
Q

what breeds are predisposed to IMHA?

A

cocker spaniels, poodles, & springers

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8
Q

what patient signalment is predisposed to IMHA?

A

female spayed, young to middle aged animal

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9
Q

what are 2 external factors that can predispose an animal to developing IMHA?

A
  1. antibiotics with a hapten group – penicillins & cephalosporins
  2. rickettsial or bacterial infections triggering immune system
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10
Q

what can be seen on physical exam on a patient with IMHA?

A

pale MM, may be icteric, poor pulse quality, pigmenturia, tachypnea

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11
Q

what lab abnormalities are commonly seen with IMHA?

A

severe leukocytosis with left shift, can fluctuate with MCV/MCHC, anisocytosis, macrocytosis, nRBC, +/- Heinz bodies

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12
Q

what are the red & yellow arrows indicating in the serum seen on PCV?

A

red – hemoglobin
yellow – bilirubin

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13
Q

what is expected of a PCV/TS in an animal with IMHA?

A

usually normal or high total solids

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14
Q

what is classic of IMHA on a blood smear?

A

spherocytes – dogs
agglutination – macroscopic or microscopic, but differentiate from rouleaux

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15
Q

what may be seen on a chemistry panel of a patient with IMHA?

A

variable depending on underlying problem & type of hemolysis - +/-:
increased bilirubin, hepatopathy, hyperglobulinemia, & azotemia (pre-renal or renal) often from intravascular hemolysis & subsequent AKI

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16
Q

why do abdominal rads in a patient with IMHA?

A

rule out zinc toxicity

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17
Q

what are some negative prognostic markers for IMHA?

A
  1. intravascular hemolysis
  2. presence of concurrent thrombocytopenia – evans syndrome or babesia
  3. persistently non-regenerative
  4. increasing number of blood transfusions
  5. degree of hyperbilirubinemia
  6. azotemia
18
Q

only intravascular hemolysis causes what 2 lab abnormalities?

A

hemoglobinuria & hemoglobinemia

19
Q

why is it important to rule out infectious causes for patients with intravascular hemolysis?

A

consider necessary immunosuppression

20
Q

what are some absolute ‘triggers’ for transfusing an IMHA patient?

A

PCV <12% or the animal is unstable

21
Q

why is it ideal to give an IMHA patient packed RBC instead of whole blood?

A

whole blood is more inflammatory/immunogenic

22
Q

transfusions make it difficult to assess what CBC parameters of your patient?

A

reticulocytes, RBC parameters, & agglutination

23
Q

T/F: it Is very rare for cats to have IMHA

A

true

24
Q

prior to immunosuppressing a cat with suspected IMHA, what should you do?

A

treat for mycoplasma

25
Q

what steroid therapy is used for IMHA patients initially?

A

steroids – injectable dex or dex sp at 2 mg/kg/day until patient is eating

26
Q

why use clopidogrel in a patient with IMHA?

A

anti-platelet agent because IMHA patients are prone to thromboembolisms

dose 1-2 mg/kg/day

27
Q

when should you add a secondary non-steroidal immunosuppressant for an IMHA patient?

A

technically every IMHA, but especially when negative prognostic factors are present such as: intravascular hemolysis, non-regenerative anemia, & multiple blood transfusions

28
Q

what is the action & dosage used for cyclosporine?

A

inhibits normal t cell function – dose at 5 mg/kg PO twice daily

29
Q

what are the pros & cons of using cyclosporine?

A

very good immunosuppressant that can be monitored with a pharmacodynamic assay

expensive & animal is most susceptible to fungal disease in certain parts of the country

30
Q

what care must be used when you put an IMHA patient on cyclosporine?

A

monitor very closely for fungal disease – wipe paws with chlorohexidine wipes every time the animal goes outside, swims, or digs in dirt

ideally limit exposure to outside world while immunosuppressed

31
Q

when are IMHA patients discharged?

A

when they are eating & drinking, taking oral meds well, PCV/TS stabilizing/holding well, & no longer requiring transfusions

32
Q

what monitoring should be used for IMHA patients once they leave the hospital?

A

recheck PCV/TS, agglutination, spherocytes, or CBC – weekly until PCV reaches at least 30%

33
Q

when do you taper steroids or secondary immunosuppressants in your IMHA patients?

A

normal Hct/PCV >30% for at least 2-3 weeks

taper in 25% increments every 3-4 weeks

taper steroids first then secondary agent

34
Q

what should you do if you have a refractory case of IMHA?

A

look for missed trigger, ensure gi bleeding isn’t a confounding problem, & reassess for infectious disorders

35
Q

babesia in dogs is nearly identical to what two concurrent diseases?

A

concurrent IMHA & IMTP – evans’ disease

36
Q

what animals are predisposed to babesiosis?

A

splenectomized animals

pitbulls & greyhounds

37
Q

how do you rule out babesia in dogs?

A

species specific PCR if you don’t see the organism in RBC & capillary blood test from the ear or nail bed to look for the organism

38
Q

picture of babesia – what is this organism seen in this blood smear?

A

babesia

39
Q

what infectious process in cats mimics IMHA? how do you treat this?

A

mycoplasma – treat all cats with doxycycline or pradofloxacin prior to starting steroids

40
Q

what are some other disorders that mimic IMHA? how do they mimic it?

A

babesia in dogs, mycoplasma in cats, zinc, & copper toxicity

can have spherocytes & agglutination

SA DX & TX I (59 decks)

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