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A-vin Night > IMHA Canine only-specific > Flashcards

IMHA Canine only-specific Flashcards

1
Q

Can vaccines to contribute to IMHA?

A

Yes, just like drugs.

So it is important to ask the vaccination history

Also ask travel hx to r/o babesia, Ehrlichia, Mycoplasma

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2
Q

Main thing to tell to owner regarding the duration of rx?

A

No improvement in 24 h

Can take 3-7 days to work

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3
Q

Diagnosis for IMHA?

A
  • 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
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4
Q

when to do Coomb’s test?

A

If negative slide agglutination and no spherocytes seen under microscope

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5
Q

4 things to look for when you do manual differential or morphology?

A
  • regenerative?
  • spherocytes?
  • platelet estimate?
  • nRBC?

Always send out for full CBC pathologist review

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6
Q

How many views for CXR and why CXR?

A

3 views

To r/o pneumonia, cancer

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7
Q

Why AXR?

A

R/o zinc toxicity, cancer hunt and other weird things such as pyometra

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8
Q

Alternative for tick PCR if low tick area?

A

4dx

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9
Q

Why UA?

A

Look for Hb in urine and for UC to r/o UTI

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10
Q

When do we check coagulation panel?

A

If evidence of DIC

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11
Q 
Mainstay therapy points for IMHA?
-
-
-
-
A

-stop all other medications
- Start immunosuppresives
-Start Rx to prevent thrombo-embolism
+/- Antibiotics
+/-Omeprazole
+/- IV fluids

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12
Q

Which immuno-suppressive to use as 1st line agent?

A

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

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13
Q

Dose for Dexamethasone and prednisone ?

A

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)

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14
Q

Best medication approach to prevent thrombo-embolism?

A

Clopidogrel +/- Aspirin

Donot use if platelets < 50,000

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15
Q

Doses of clopidogrel and aspirin?

A

Clopidogrel - 1-3 mg/kg PO SID

Aspirin 0.5 mg/kg PO SID

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16
Q

-

A

If travel history

If concurrent low platelets

17
Q

When are IV fluids indicated?

A

If hemoglobinruia or hemoglobinemia suspected

18
Q

Consider ________ if refractory IMHA or relapsed patient.

A

Spleen removal

19
Q

Name three second line immuno-suppresive agents?

A
  • Azathioprine
  • Cyclosporine
  • myco-phenolate
20
Q

Tranfuse atleast by _____ PCV and aim for ____ PCV

A

15%

Mid 20s

21
Q

What to use for tranfusion?

A

<30,000 platelets → FRESH whole blood
>30,000 platelets → packed RBC

    • use type specific blood and consider cross match
    • use freshest blood possible
22
Q

Cross match is MUST if over ___ days after 1st tranfusion.

A

4

23
Q 
What to monitor on minimum on daily basis?
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-
-
-
A

PCV/TS q8-24h
Blood smear q24h
Slide agglutination q24h
Tbilirubin, Hb in blood and urine (as these are poor prognostic indicators)

24
Q

Studies have shown poor prognosis if Tbili goes over ____ during hospitalisation

A

5-8

Normal is 0-0.3 mg/dl

25
Q

Monitoring for cyclosporine while hospitalization?

A

trough levels at 48 hr

26
Q

Home instructions regarding medications?

A
  • 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
27
Q

When to come back for testing once pet with IMHA is discharged?

A
  • CBC/Chem twice a month for 2 months, then monthly

- UA +/- UC every 12 weeks while on corticosteroids

28
Q

How to do SAT test?

A

Observe the slide grossly over 2 minutes for GROSS AGGLUTINATION and then look under the microscope

29
Q

How to differentiate ROULEAUX formation from AUTO-AGGLUTINATION?

A

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.

30
Q

Is this AUTOAGGLUTINATION or ROULEAUX FORMATION?

A

Rouleaux formation

Consistent with agglutination

A-vin Night (9 decks)

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