IMHA Canine only-specific Flashcards
Can vaccines to contribute to IMHA?
Yes, just like drugs.
So it is important to ask the vaccination history
Also ask travel hx to r/o babesia, Ehrlichia, Mycoplasma
Main thing to tell to owner regarding the duration of rx?
No improvement in 24 h
Can take 3-7 days to work
Diagnosis for IMHA?
- CBC/Chem/UA
- Slide agglutination, manual differential , morphology & send for CBC pathologist review
+/- if no agglutination, spherocytes then Coomb’s test
-CXR and AXR
-AUS
-PCR Tick borne panel
-Blood typing
+/- Coagulation panel
when to do Coomb’s test?
If negative slide agglutination and no spherocytes seen under microscope
4 things to look for when you do manual differential or morphology?
- regenerative?
- spherocytes?
- platelet estimate?
- nRBC?
Always send out for full CBC pathologist review
How many views for CXR and why CXR?
3 views
To r/o pneumonia, cancer
Why AXR?
R/o zinc toxicity, cancer hunt and other weird things such as pyometra
Alternative for tick PCR if low tick area?
4dx
Why UA?
Look for Hb in urine and for UC to r/o UTI
When do we check coagulation panel?
If evidence of DIC
Mainstay therapy points for IMHA? - - - -
-stop all other medications
- Start immunosuppresives
-Start Rx to prevent thrombo-embolism
+/- Antibiotics
+/-Omeprazole
+/- IV fluids
Which immuno-suppressive to use as 1st line agent?
Corticosteroids such as prednisone or Dexamethasone SP
If pet has concurrent disease such as DM, then steroids are bad idea. In that case, use other drugs
Dose for Dexamethasone and prednisone ?
Dexamethasone 0.2 -0.3 mg/kg IV as starting medication if pet is not eating or vomiting and then starting prednisone 2 mg/kg total dose for 24 hr (give 1 mg/kg BID)
Best medication approach to prevent thrombo-embolism?
Clopidogrel +/- Aspirin
Donot use if platelets < 50,000
Doses of clopidogrel and aspirin?
Clopidogrel - 1-3 mg/kg PO SID
Aspirin 0.5 mg/kg PO SID
-
If travel history
If concurrent low platelets
When are IV fluids indicated?
If hemoglobinruia or hemoglobinemia suspected
Consider ________ if refractory IMHA or relapsed patient.
Spleen removal
Name three second line immuno-suppresive agents?
- Azathioprine
- Cyclosporine
- myco-phenolate
Tranfuse atleast by _____ PCV and aim for ____ PCV
15%
Mid 20s
What to use for tranfusion?
<30,000 platelets → FRESH whole blood
>30,000 platelets → packed RBC
- use type specific blood and consider cross match
- use freshest blood possible
Cross match is MUST if over ___ days after 1st tranfusion.
4
What to monitor on minimum on daily basis? - - - -
PCV/TS q8-24h
Blood smear q24h
Slide agglutination q24h
Tbilirubin, Hb in blood and urine (as these are poor prognostic indicators)
Studies have shown poor prognosis if Tbili goes over ____ during hospitalisation
5-8
Normal is 0-0.3 mg/dl
Monitoring for cyclosporine while hospitalization?
trough levels at 48 hr
Home instructions regarding medications?
- Prednisone 1 mg/kg PO BID for atleast 1 month- decrease dose very slowly
- Continue Clopidogrel +/- low dose aspirin for atleast 1 month
- Consider Omeprazole while on high dose of prednisone
When to come back for testing once pet with IMHA is discharged?
- CBC/Chem twice a month for 2 months, then monthly
- UA +/- UC every 12 weeks while on corticosteroids
How to do SAT test?
Observe the slide grossly over 2 minutes for GROSS AGGLUTINATION and then look under the microscope
How to differentiate ROULEAUX formation from AUTO-AGGLUTINATION?
To further differentiate rouleaux from autoagglutination, add 1-2 drops of saline to 1 drop of blood on a glass slide and cover with a coverslip. Rouleaux should disperse upon addition of saline.
Is this AUTOAGGLUTINATION or ROULEAUX FORMATION?
Rouleaux formation
Consistent with agglutination
