IMHA/ITP

Question 1

If you get an epistaxis or bleeding patient, and you seen petechie when you open the mouth, what does it tell you?

Answer 1

That the dog has lack of 1º hemostasis

Most commonly due to severe ↓ platelets in dogs

Question 2

Most common cause of Petechiae in mouth in dogs is due to _____

Answer 2

Severely ↓ platelets

Lack of 1º hemostasis

Question 3

In dogs, the most common cause of SEVERELY ↓ platelets is _______

Answer 3

ITB !!!!

Immune mediated process

Question 4

Diagnostics which should be considered in any pet with IMHA/ITP?
-
-
-
-
-

Answer 4

CBC/Chem
UA
Clotting times
CXR & AUS 
Tick titers or Tick PCR

Question 5

ITP/IMHA can further be 1º or 2º . Please elaborate?

Answer 5

1º - usually idiopathic(we can’t find trigger)

2º - Drug reaction , infection, Cancer

Question 6

Author recommends getting urine via cystocentesis in these cases. T/F

Answer 6

F

Not via cysto

Question 7

Why does author strongly recommend Urinalysis?

Answer 7

UTI can trigger immune response

Question 8

Tick PCR is based on disease prevalence in area. T/F

Answer 8

T

Question 9

Most common cause of death in ITP/IMHA over long run.

Answer 9

Thrombo-embolism

Animals almost never die of anemia

Question 10

-
-

Answer 10

• pet will not get better in 24 hr

- 50-70% can be discharged from hospital but that one year mortality can reach 70%

Question 11

Survival is poorer for dogs with melena vs those without. T/F

Answer 11

T

Question 12

Median hospitalization time for dogs with ITP is ____ days

Answer 12

4 days

Question 13

Keeping HCT high increases ability to clot even if we donot give platelets. T/F

Answer 13

T

Question 14

3 main differentials for IMHA?

Answer 14

• Zinc toxicity
• Heinz body anemia from oxidant damage
• PK and other RBC enzyme deficiencies

Question 15

ZINC toxicity can be caused due to ______ and ______ mainly

Answer 15

Pennies

Desitin type diaper cream

Question 16

Onion and garlic cause heinz body anemia from oxidant damage. T/F

Answer 16

T

Question 17

Diagnostics recommendations for IMHA is same as ITP. T/F

Answer 17

T

Question 18

Why are XRAY recommended in cases of suspected IMHA?

Answer 18

R/o Cancer and Heavy metals in stomach

Question 19

Mainstay therapy in ITP/IMHA is ________

Answer 19

Corticosteroids

Question 20

Options for corticosteroids for IMHA?

Answer 20

Prednisone 2 mg/kg PO BID to start

If pet does not tolerate oral medication, then DEX XP 0.3 mg/kg IV

Question 21

What about using a second immunosuppresive agent ?

Answer 21

Controversial

Other options are Aza-thio-prine , Myco-phenolate , cyclosporine

Question 22

2 most common causes of mortality in cases of IMHA?

Answer 22

Venous thrombus
PTE

Thromboembolism !!!!

Question 23

Best option currently for Thrombo-embolism prevention?

Answer 23

Clopidogrel(Plavix)

Other option is aspirin but it does not work in all dogs at the recommended dose

Question 24

Heparin of any type if not the best option for Thromboembolism prevention .T/F

Answer 24

T

Best option currently if Plavix/Clopidogrel