Haematology and Immunology Flashcards
What is the relationship of IL-17 with IMHA to healthy control dogs and at what time points may measuring IL-17 be of prognostic value?
It was NSD to healthy dogs at admission for IMHA. However, it was found to be higher on days 2 and 4 in non-survivors. n.b. the study may be underpowered.
Note: Il-17 = pro-inflammatory, involved in recruitment and activation of neutrophils, monocytes and endothelial cells. It is secreted by TH-17 cells.
How do point-of-care crossmatch kits (gel and immunochromatographic methods) correlate with laboratory crossmatch methods in dogs? Is this similar to the situation in cats?
They detect less crossmatch incompatibilities compared to the lab method in both dogs and cats. There has not been work (at time of writing 18/12/22) that shows this is clinically relevant in dogs. But in cats the point-of-care techniques correlate better to clinical incompatibility.
https://paperpile.com/app/p/0b13c6d8-92ec-0f1d-8ae3-9f7df827af0f
What is the level of kappa agreement in gel-based crossmatch and immunochromatograhic based crossmatch kits compared to laboratory methods in ill dogs?
Gel-CM - no value available due to lack of incompatible results.
IC techniques had a kappa of 0.16
What is the % of dogs that are transfusion-naive vs dogs having a prior transfusion that are lab-crossmatch incompatible?
25% and 35% (NSD)
https://paperpile.com/app/p/0b13c6d8-92ec-0f1d-8ae3-9f7df827af0f
What proportion of dogs with chronic enteropathy are deemed to be hypercoaguable on TEG and how does this percentage correlate to dogs that had a low albumin and healthy dogs?
44.7% of dogs with CE overall.
57.8% hypoalbuminaemic dogs
31.5% of dogs without hypoalbuminaemia
https://paperpile.com/app/p/270e7dc1-c4bb-01c8-88e3-e27e25d5f471
What are the risk factors for development of hospital acquired anaemia?
Surgical patient
Number of blood samples (5 vs 7)
Being a cat (dogs more likely not to surive if anaemic)
Total blood sample ≥3% estimated total blood volume
https://paperpile.com/app/p/a248070a-82cd-0e03-a464-2b9a0c9ac539
What factors are prognostic for survival in cats with primary IMHA?
Bilirubin concentration (higher = worse)
Age (higher = worse)
Globulin concentration (higher = better)
Lymphocyte count (higher = better)
https://paperpile.com/app/p/ef8a9209-d393-041b-8460-313eda07ae1c
What age of cats is associated with increased chance of having primary IMHA?
2.1 - 5.9 years
https://paperpile.com/app/p/ef8a9209-d393-041b-8460-313eda07ae1c
What adverse effects were noted following intraperitoneal injection of cats with MSC stem cells?
2x lethargy and decreased activity
Increased LN size
1 cat had a hyperechoic renal cortex
The basis of this study is that MSC can regulate inflammation and induce Treg activity
https://paperpile.com/app/p/a577039e-9f88-0c1b-a9c1-252e4f642d9b
Following MLV intranasal vaccination for Bordetella bronchiseptical, CAV-2 and canine parainfluenza, how many days will animals be positive on PCR detection of these organisms (nasal and pharyngeal swabs)
Up to 28 days, possibly longer, with the majority of positive samples between days 3 - 10 post-vaccination.
https://paperpile.com/app/p/5d4836fd-b10f-04a0-94d2-6b3648ccd176
What was the effectiveness, side-effect profile and prognosis following oral treatment of canine disseminted aspergillosis with posaconazole?
5mg/kg PO q12h was used, 4 dogs entered disease remission and 6 had clinical improvement. Most dogs relapsed either whilst on treatment or shortly after discontinuation. The MST was 274 days. No clinicially relevant adverse effects occured.
https://paperpile.com/app/p/62222040-940a-04ac-be59-7d473f2cbdc2
What are the prognositc markers for acute babesiosis?
Non-survivors:
- Higher lactate, TG and phosphate
- Lower HCT, leukocyte counts, thrombocyte counts
All survivors had leukocyte counts within the reference range
All non-survivors had hyperlactaemia
https://paperpile.com/app/p/92ec35e3-b45f-0d40-b5a4-be8add889eee
Does addition of ciclosporin to a low-dose aspirin treatment protocol affect platelet function?
Not on day 3 but there is a difference after 7 days of treatment
https://paperpile.com/app/p/018e7d4b-fe23-08b3-875e-93f337e82b99
Which of the following is increased faecal calprotectin assocaited with in puppies?
a) Moisuture of faeces
b) Increased IgA sheddingh
c) Increased faecal pathogen shedding
d) Younger age
d
https://paperpile.com/app/p/15a51bea-5ab1-0b3a-ba03-2c4cccd52973
Which of the following is increased faecal IgA assocaited with in puppies?
a) Moisuture of faeces
b) Increased faecal calprotectin sheddingh
c) Increased faecal pathogen shedding
d) Younger age
c
https://paperpile.com/app/p/15a51bea-5ab1-0b3a-ba03-2c4cccd52973
What is the most common Kai blood type of dogs in North America, what relationship is there with this blood type and DEA status?
- KAi1+/2- in 94% dogs
- Kai1-/2- 5%
- Kai 1-/2+ in 1%
No relationship of Kai type and DEA
https://paperpile.com/app/p/338e0a33-c8f1-04b0-87cf-f6f6dc990646
Relationship of RDW to pulmonary hypertension
Dogs with precapillary and postcapillary PH had significantly increased RDW compared to healthy dogs.
Severity of PH, peak tricuspid regurgitation pressure gradient, and other variables were associated with RDW. (urea, age, HCT and WBC count)
https://paperpile.com/app/p/5079a3b6-71d2-0267-9271-e1816ac56ac3
How long can canine whole blood units likely be stored for with a low risk of bacterial contamination?
42 days according to this study:
https://paperpile.com/app/p/9bdecaef-a9c8-06c9-9c69-b23c5e5bffef
What findings have indicated that ascitic fluid (in dogs) may have coagulation activity?
Increased FDPs and D-dimers and lower fibrinogen than plasma
https://paperpile.com/app/p/25356e73-33fa-08e9-a418-798565226934
Breeds with the highest prevalence of Dal blood type and mode of inheritance
Dalmations, dobermans and Shih Tzu
Autosomal dominant
What predonation factors impact on platelet levels in platelet concentrates?
Platelet count, lipmic index and phosphorus levels
https://paperpile.com/app/p/32df3894-c751-08cd-9a20-30d2481f9b7b
Most common reasons for thrombocytosis in dogs.
Secondary thrombcytosis associated most frequently with neoplasia (55.7%) followed by inflammatory disease (46.6%) then endocrine disease (12%). Most common inflammatory disease was immune mediated associated with glucocorticoid administration.
https://paperpile.com/app/p/5586a7b7-326c-0613-aee6-5034de40e229
Percentage of felien blood samples that have incorrect lymphocyte/neutrophil counts using ProCyte
- 13% of felien samples had falsely increased lymphocyte and decreased neutrophil counts in 13% of cases. Rejection of the dotplot avoids the error.
https://paperpile.com/app/p/69b4c74f-0f5b-0b7c-84b9-0339cd00ca3c
What is the proportion of cell-free hiDNA in blood of dogs with IMHA?
94% samples
What is the predominant histone in dogs with IMHA?
H3
What drug has been shown to reduce complement mediated haemolysis in vitro reliably?
Recombinan human C1-esterase inhibitor [c1-INH) (compstatin is a C3 inhibitor and this was less reliable when a different type was used in the same study)
What reduction in iCa can be expected when citrate is used in regional anticoagulation of haemodialysis?
0.23mmol/L
What genetic varient has been noted in pomeranians with familial methaemoglobinaemia
CYBR3 (codes fo NADH-cb5 reductase)
Which leptospirosis test(s) have been shown to detect infection earliest?
WITNESS Lepto Immunoglobulin M assay follwed by MAT then the leptoSNAP (Which was crap)
What is the MST for dogs with MM treated with melphalan?
930 days
Negative prognostic indicators for melphalan treated dogs with MM
- Renal disease
- Neutrophil:Lymphocyte ratio
Which second agent has been shown, in some studies, to affect coagulation status in dogs?
Cycloporin, although snot in all studies
What effect on the haemostatic system of dogs with Ehrlichia has been noted?
Decreased PLT count and presence of anti-platelet antibodies.
- However, increased platelet activation and hypofibrinolysis have also been noted.
Which babesia species has been noted in greyhounds and is this clinically relevant?
Babesia conradaei - in those that have exposure to coyote fighting.
these dogs were noted to have reduced HCT, leukocyte counts, platelet counts and albumin
Does 6% tetrastarch impact coagulation of dogs?
Not in the study that looked at this comparing it to treatment with LRS
Does hypocobalaminaemia seem to be associated with increased anaemia in dogs?
No
What test may be equivalent to the clauss method of detecting fibrinogen
MCF FIBTEM
What is the relationship between serum calprotectin, S100A12 and hyperlipidaemia in miniature schnauzers?
Calprotectin was increased in dogs with high TG with or without hyperCHOL but not in dogs that only had hyperCHOL. The increase in calprotectin was persistent despite treatment with a low fat diet and normalisation of TGs
n.b. both CHOL and TG were correlated to calprotectin
What percetage of dogs treated with TPE following NSAID intoxitaction developed and AKI?
27.3%
What is the agreement between monoclonal antibody based urine histoplasma antigen and the tranditional urine ELISA for the diagnosis of histoplasa?
Moderate - k 0.44
What tests can be performed to extrapolate anti-Xa activity in rivaroxaban treated dogs?
TEG R value and PT (1.5 - 1.9x delay in PT associated with therapeutic anti-Xa levels)
What is the effect of pregnancy on cobalamin status in dogs, their iron status and effect on neonatal survival.
Cobalamin decreases in late pregnancy and iron and transferrin saturation increase. There was no association with cobalamin/folate and neonatal survival. Increasing parity was associated with decreases of cobalamin (1 parity = 28.6pg/mL decrease in cobalamin)
Which interleukins are reduced in GSD duodenal tissue with chronic enteropathy compared to non-GSD CE dogs
IL 33 and IL 13
What percentage of cats treated with oral mycophenolate mofetil with transform this to mycophenolic acid?
100%
What vWF type has been noted in dogs with AKI
Type II-like
How long after tranfusion of a DEA -ve dog with DEA 1+ posiive dog are autoantibodies againt DEA1+ antigen likely to persist?
> 1657 days (4.5 years!)
Which lymphocyte immunophenotypes in cats with lymphocytosis are:
- More likely to be assocaited with neoplastic vs. non-neoplastic diseases
- Which immunophenotype is associated with the shortest survival time
B-cell and heterogenous populations are less likely to be associated with a neoplastic process
CD4+ is most common in neoplastic phenotypes
CD5-low T-cell had the shortest survival times
What percentage of normal vs. IMTP dogs have anti-platelet antibodies?
20% normal dogs
100% IMTP dogs
What is the OR of a relapse in dogs with IMTP that re-develop APA antibodies?
205x
What is the chance of prednisolone + clopidogrel treated dogs having hypocoaguability?
11x
Which immunosupressive drugs affect IL2 and IFN levels?
Prednisolone and ciclosporin
How could NETs be reduced in canine stored blood?
Using lukoreduction prior to storage reduced cell-free DNA and cH3 levels
What percetage of non-domesticated canids are DEA 1+ and which of the following is most appropriate?
- Transfusion of domesticated caids with nondomesticated canid blood
- Transfusion of nondomesticated canid with domesticated canid blood
72.9%
Option 2 is more appropriate as there were less crossmatch incompatibilities in this scenario (althoug hstill 50% or so)
What dilution ratio of saline:blood has the highest specificity for diagnosis fo IMHA?
49:1
Are lipopylised platelts better than cryopreserved platelets?
At 1h post transusion yes, but at 24h they are non-inferior
Which of the following statements is correct:
a) CRP is a more sensitive marker of discospondylitis than other clinical parameters
b) CRP correlates to positive bacterial culture in dogs with discospndyltitis
c) CRP predicts remission of discospondylitis
d) CRP predicts worse discospondyltitis (i.e. with muscular involvement, empyema)
a
What interleukin has been shown to be potentially prognostic for IMHA in dogs?
IL-17, infered by a significant reduction in IL-17 after D2-4 hospitalisation and that IL-17 was significantly decreased overall in survivors.
n.b. IL17 was not significantly different in IMHA vs. healthy controls on admission although was noted to trend higher
Which immunosupressive drug should potentially be avoided alongside vincristine in the treatment of IMTP?
Ciclosporin - this has been shown to have an increased risk of neutropenia in vincristine treated dogs and dogs that were neutropenic had an increased duration of hospitalisation.
Which felien non-AB antigen is associated with the presentation of naturally occuring alloantibodies?
FEA 1 negativtiy. Thought hat FEA 1 may be the mik antigen
Which canine breeds are predisposed to PIMA
Whippets, lurchers and miniature dacshunds
What red cell indice has been shown to be prognostic for PIMA?
cRT% > 0.2
What is the response rate of IMHA dogs treated with TPE and their percentage of survival to discharge?
83% responded which was significantly different to controls (65%)
82% survived to discharge
What is the response rate of IMTP dogs treated with TPE?
80% which was NSD to controls (70%)
What is the effect of leukoreduction on storage lesions of canine blood units?
LR was associated with improved lactate, pH and potassium along with a smaller decrease in IL8.
However, LR has been shown not to have an impact on the number of transfusion reactions or changes to % increase in HCT following transfusion in dogs.
What seemed to be the most commonly detected blood bourne pathogen in blood units in canada?
Anaplasma
What evidence is there that vincristine does truly increase functional platelet counts?
A healthy dog study showed a significant increase in platelet count in healthy dogs given vincristine 7d after administration. Reticulated platelets also increased (stained with thiazole orange) and expressed CD62P which is a marker that suggests function
What percentage of dogs may experience adverse effects with MM administraiton, which was the most common effect?
25.9%, most common was GI
What are the risk factors for death in dogs with splenic torsion?
Septic peritonitis, intraoperative haemorrhage, post-operative respiratory distress
What percentage of hypotensive cats are likely to survive to discharge from hospital and what clincal parameter may be prognostic for survival?
15%
Lactate
Which small breed dog is more likely to have splenic neoplasia than other small breed dogs with splenopathy?
Wheaten terriers
What presenting characteristic is associated with malignancy in small breed dogs with splenic disease?
Presence of haemoperitoneum
Which breed has a higher OR of arterial thromboembolic disease?
Shetland sheepdogs
What is the most common comorbidity associated with arterial thromboembolic disease in dogs?
PLN
How much blood volume loss is associated with the development of hospital acquired anaemia?
> 3% estimated total blood volume
What is the relevance of mean platelet component concentration in dogs with IMHA?
Lower MPC was associated with worse outcome, partcularly values <19.1g/dL
Which erythrocyte morphological change is more likely in dogs with lymphoma compared to those with inflammatory bowel disease?
Eccenterocytosis
When presented with a dog with haemoabdomen, what should be noted about the sensitivity of detecting a cause using abdominal ultrasound?
Sensitivity for detection of:
- Splenic mass 87.4%
- Hepative mass 37.3%
- Mesenteric massess 31.3%
None of the dogs in this study with metastatic mesenteric nodules had these detected on AUS
What factors do not seem to influence POC HCT readings?
Haemolysis, lipaemia, agglutination, reticulocyte count
Evidence for crossmatching cats and dogs
- A study in JVIM 2018 showed that major crossmatching did not decrease the incidence of transfusion reactions in transfusion naïve cats1
- However, a study later in that year showed that 10.1% of non-crossmatched cats had FNHTR compared to 2.5% in cats that were crossmatched even when blood typed, supporting the use of crossmatching in cats2. In this study the presence of crossmatching was not associated with survival to discharge.
- Gel based crossmatch kit identified more crossmatch incompatabilities outside of A-B incompatibilities but a gel-column mthod did not. Overall there was good agreement between tests3
Dogs: 17% dogs will be crossmatch incompatible and HCT is higher following transfusion of crossmatched units.
