Module 15 Wk 2 Flashcards
(Approach to Anaemia in Small Animals)
What is anaemia?
Reduction in the haemoglobin concentration of the blood so Reduced oxygen-carrying capacity
T/F with regenerative anaemia, you will see reticulocytes in the circulation.
true
What are examples of non-regenerative anaemia?
- Primary bone marrow disease
- Iron deficiency anaemia – withholding iron from RBC production
- Anaemia of Inflammatory Disease
- Chronic renal failure
- Endocrine disease e.g. hypothyroidism
- Cobalamin deficiency
What are the two catagories of regenerative anemaia?
Haemolysis
Heamorrhage
Give examples of haemolysis and haemorrhagic anaemia.
Haemolysis
* IMHA
* Infectious
* Oxidative injury
* Metabolic disorders
Heamorrhage
* Trauma
* GI Ulceration
* Haemostatic disorder
* Ruptured neoplasm
With primary bone marrow disease as the cause of non-regenerative anaemia, what are the main differential diagnoses?
- Pure Red Cell Aplasia – failure of red cell line
- Aplastic Anaemia
- Myelofibrosis - fibrous tissue replacing bone marrow
- Bone Marrow Infiltration
- Myelodysplastic Syndromes – cats – disordered RBC production, odd cells in blood – uncommon
With Secondary failure of erythropoiesis as the cause of non-regenerative anaemia, what are the main differential diagnoses?
- Anaemia of inflammatory disease
- Chronic renal failure
- Endocrine disease
- Haemoglobin synthesis defects - Fe deficiency
- Nuclear maturation defects - Cobalamin deficiency
What does the secondary failure of erythropoiesis mean?
BM could produce RBC if had sufficient building blocks. Not BM disease.
What are clinical signs of primary bone marrow disease causing non-reg aneamia?
- lethargy
- weakness
- exercise intolerance
- Relatively BAR
- Other cell lines may be affected such as thrombocytopenia/neutropenia
When it comes to secondary failure of erythropoiesis, the clinical signs come from the primary disease process. what are the clinical signs for chronic renal failure?
PUPD, reduced appetite, weight loss, vomiting
When it comes to secondary failure of erythropoiesis, the clinical signs come from the primary disease process. what are the clinical signs for hyperthyroidism?
It is a dermatological disease
When it comes to secondary failure of erythropoiesis, the clinical signs come from the primary disease process. what are the clinical signs of iron deficiency?
It is typically associated with chronic low grade external blood loss due to parasitism (internal or external), ulcerative GI disease, chronic urinary losses
When it comes to secondary failure of erythropoiesis, the clinical signs come from the primary disease process. what are the clinical signs of cobalamin deficiency?
chronic GI disease, or on rare occasions genetic defects resulting in inability to absorb vitamin B12
What is immune-mediated haemolytic anaemia?
It is a condition in which the immune system mistakenly targets and destroys red blood cells, leading to anemia and is characterized by the premature destruction of red blood cells.
If the red blood cells are destroyed in the blood what type of haemolysis is this?
intravascular hemolysis
If the premature destruction of red blood cells occurs in organs what type of haemolysis is it?
extravascular hemolysis
What are the two classifications of IMHA?
Primary and secondary
What is primary IMHA?
It is where the immune system directly attacks the red blood cells without an identifiable trigger
Secondary IMHA is triggered by an underlying conditions or external factor, what can these be?
- Infectious - Bacterial or Parasitic
- Drug-induced - like Sulphonamides, penicillins, vaccines
- Neoplasia – antibodies cause a secondary IMHA
How would you diagnose Feline infectious anaemia as a cause of IMHA?
PCR - often coombs positive
What things can lead to IMHA?
- Paracetamol toxicity
- Onion toxicity
- Benzocaine
- Zinc toxicity
- Propofol infusion
- Diabetes mellitus, hepatic lipidosis in cats
What are clinical signs of IMHA?
- Jaundice
- Haemoglobinuria (intra-vascular)
- Hepato-splenomegaly
- Pyrexia
- Chocolate-coloured oral mm as a sign of MetHb
What lab evaluations should you do for an anaemic patient?
- PCV
- Blood Smear evaluation
- Reticulocyte assessment
- Complete Blood Count
- Serum biochemistry
- ISA, Coagulation times
On a PCV is you get 20-30% is it mild, mod or severe?
mod
On a PCV if you get less than 20 percent, is the anaemia mild, mod or severe?
severe
If your PCV gives you 30-39% is the anaemia mild, mod or severe?
mild
T/F Anaemia is non-regenerative if <50% of expected reticulocyte response
True
If the patient has other cell lines afftected what do you think the anaemia could be due too?
Could the anaemia be due to bone marrow failure
With primary BM disease what do you see on sblood smear?
- normocytic normochromic anaemia
- Concurrent bi-cytopenia ( reduction in two of the three) or pan-cytopenia (reduction in all 3)
When it comes to secondary failure of erythropoiesis, what do the cells look like when it’s iron deficiency?
microcytic hypochromic anaemia
When it comes to secondary failure of erythropoiesis, what is see on lab results for chronic renal failure?
azotaemia = elevated level of nitrogenous waste products, primarily urea and creatinine, in the blood.
What are distinguishing lab features that indicated IMHA
- Regenerative anaemia
- Spherocytosis
- Leucocytosis due to a neutrophilia +/- left-shift
- concurrent immune-mediated thrombocytopenia
- Hyperbilirubinaemia
- Evidence of organ dysfunction e.g. increase ALT, increase cPLI
What is spherocytosis?
A condition where red blood cells become abnormally spherical in shape, rather than the normal biconcave disk shape. This abnormality affects the cells’ ability to function properly, particularly their ability to pass through small blood vessels and the spleen, leading to hemolysis (destruction of red blood cells) and anaemia.
What further investigations should you do for an anaemic patient?
- Identify and address any underlying disease process
- Supportive care - transfusion
- Immunosuppressive drug therapy
What is the mortality rate of patients with anaemia?
25-70%
What are the main causes of death in anaemic patients?
- Refractory to Therapy
- Hypoxaemia
- Pulmonary Thromboembolism
- Disseminated Intravascular Coagulation
(Disorders of Haemostasis in Small Animals)
What is the definition of heamostasis and what happens if you reduce and increase it?
Haemostasis is the stopping of the flow of blood
- reduction results in bleeding
- increment too much results in thrombosis
What is primary haemostasis?
The platelet plug is formed via vascular endothelium, platelets, and von Willebrand factors, which bind the subepithelial and platelets and then the platelets into place.
What is secondary haemostasis?
The stabilisation of the platelet plug. Coagulation proteins and intrinsic and extrinsic clotting factors are involved here and fibrin is formed.
What is tertiary haemostasis?
The breakdown of the platelet plus via fibronlysis
What is primary haemostasis dependent on?
- PLT number
- PLT function
- Adequate vWF
- Normal vessel function
What is thrombocytopenia? and what is haemostasis is it a disorder of?
Low platelet count in the blood and its a disorder of primary haemostasis
What is thrombocytopathia? and what is haemostasis is it a disorder of?
It is platelet dysfunction and is a disorder of primary haemostasis?
What is Von Willebrands disease and what haemostasis is it a disorder of?
It is a genetic bleeding disorder caused by a deficiency or dysfunction of von Willebrand factor and is a disorder of primary haemostasis
When assessing a patient that may have a bleeding disorder, what might be clues given by the owner in the history?
- potential exposure to an anticoagulant rodenticide
- wormed? - if not, then could be angiostronglus vasorum
- Travel outside UK - Yes, then could be a vector-borne disease
- Has the dog or cat been systemically unwell in the run-up to bleeding?
What is thrombocytopenia often associated with clinically?
- Bleeding under the skin like Petechiation (pin point) and ecchymoses (larger areas)
- Epistaxis - nose bleeds
- Gastro-intestinal bleeding
- Clinical signs associated with anaemia due to blood loss
What are clinical signs of Von willebrands disease?
- Prolonged bleeding at surgical sites
- Prolonged bleeding at oestrus
- Clinical signs associated with anaemia due to blood loss
what are the clinical signs associated with coagulopathies?
- Haematoma formation
- Haemarthrosis
- Pulmonary haemorrhage
- Bleeding into body cavities
- Clinical signs associated with anaemia due to blood loss
What lab tests should you do for primary haemostasis and what should the results?
- Platelet count - less than 50x10^9/L
- buccal mucosal bleeding time - longer
What lab test should you perform for secondary haemostasis?
- Prothrombin time
- activated partial thromboplastin time
- Fibrinogen
What lab test should you perform with suspected tertiary haemostasis?
- Fibrin-degradation products FDPs
- D-dimers
What is a concerning platelet count?
< 50 x 10^9/l
What does buccal mucosal bleeding time assess?
- Platlet Function
- Vascular response to injury
- Adequacy of vWF
- bleeding should cease in 2-4mins if more then problem
What is normal activated partial thromboplastin time in dogs and cats in a VDS lab?
- Normal Dog: 10-17 secs
- Normal Cat: 15-19 secs
(Upper Respiratory Tract Disease in Small Animals)
What is stretor? And what does it indicate?
Stretor is reverbrent airflow in the upper airways which creates a snoring sound. It indicates BOAS
What is stridor? And what does it usually indicate?
Stretor is a harsh noise on inspiration. It indicated laryngeal paralysis
What does BOAS stand for?
Brachycephalic obstructive airways syndrome
What is BOAS?
Brachycephalic breeds have a shortened nasal cavity and altered nasopharyngeal anatomy, which causes turbulent airflow, inflammation, and swelling of soft tissue.
What are the primary components of BOAS?
- Stenotic nares
- Elongated and thicker soft palate
- Excess pharyngeal mucosa
- abnormality in the nasal turbinates
- Hypoplastic trachea -smaller trachea
What are the secondary components of BOAS?
- Everted laryngeal saccules
- laryngeal collapse
- Tonsillar hyperplasia and eversion
- Regurgitation
- Hiatal herna - part of the stomach slided into thorax
T/F BOAS patients are more likely to develop aspiration pneumonia
True so must always be considered
What are the symptoms of aspiration pneumonia?
- cough
- pyrexia
- Tachypneoa/dyspnoea
What is the chronic presentation of a BOAS patient?
- Stertor
- Some exercise intolerance
- Regurgitation
How would you treat a chronic BOAS patient?
- weight loss
- harness rather than lead
- keep cool, avoid stress and manage exercise.
- early surgery to prevent secondary chnages
How will a acute (emergency) BOAS patient present?
with severe dyspnoea
How would you treat an emergency BOAS patient?
- O2
- cooling
- steroids
- sedation
- GA/intubation
- Tracheostomy
What can be treated surgically primarily in BOAS?
- Stenotic nares
- Elongated soft palate
- Everted laryngeal saccules
- Tonsillar prolapse
What are more severe cases where symptoms may persist after surgery in BOAS?
- laryngeal collapse
- Hiatal hernia
What are stenotic snares?
It is where the dorsal lateral nasal cartilage collapses after birth creating increased UAW resistance
How can this be corrected via surgery?
Via wedge resection, which reduces upper airway resistance and slows the progression of other components
T/F you can diagnose elongated soft palate in a conscious patient?
False - under GA with aid of a laryngoscope
What are the markers for a soft palate in a dog?
caudal pole of the tonsils and the tip of the epiglottis
What do everted laryngeal saccules obstruct and how are they like that?
They obstruct the ventral half of the glottis, and they are pulled out by negative pressure.
Is laryngeal collapse a primary or secondary condition of BOAS?
It is a secondary condition due to increased airway pressures from upper airway disease.
T/F laryngeal collapse causes severe obstruction.
True
How would you go about treating a laryngeal collapse?
- Want to correct another airway issue first
- Modify dog’s lifestyle
- If unsuccessful, consider laryngeal surgery, but it comes at risk!!!
- permanent tracheostomy
What causes regurgitation in BOAS?
Increased negative pressure in the thorax due to increased inspiritory effort
What is laryngeal paralysis caused by?
It is caused by dorsal cricoarytenoid muscle failure, but the vocal cords and arytenoid cartilages remain in paramedian position, causing airway obstruction.
What are the three aetiology of laryngeal paralysis?
- Idiopathic
- Congenital
- Secondary
What is the most common form of laryngeal paralysis?
idiopathic
What kind of dogs are seen to have idiopathic laryngeal paralysis?
- lab retrievers
- older
- medium to large breeds
How would you treat a dog with laryngeal paralysis?
- Sedate to calm and reduce resp. rate (acepromazine)
- Corticosteroids - Dexamethasone
- Cool
- Supply oxygen
- Refer for surgery
- Temporary tracheostomy
What is aspiration pneumonia?
Where the glottis does not close when the patient swallows and food or liquid is aspirated causing pneumonia
What are the clinical signs of aspiration pneumonia?
- dyspnoea
- pyrexia
- cough
- cyanosis
- inspiratory stridor
How would you diagnose a dog with aspiration pneumonia?
Directly looking at the larynx but at the recovery of light plain ana as ana drugs suppress laryngeal function
How do you treat aspiration pneumonia?
- Cricoarytenoid lateralisation – tie back surgery
- Permanently abduct arytenoid
Where do feline nasopharyngeal polyps originate from and where can the grow to?
- They origniate in the tympanic bullae
- Either grow out the ear canal (aural polyp) or they grow down the eustatian tube into the nasopharynx.
How are nasopharyngeal polyps removed?
Removed by traction - Approach through oral cavity and retract soft palate rostrally. Grasp and apply steady traction to the polyp until it avulses.
What may removal of nasopharyngeal polyps result in?
horner syndrom or vestibular signs
(Therapeutics for Small Animal Haematological Diseases -Transfusion Medicine)
What are the types of immunological transfusion reaction that can occur?
Haemolytic and non-heamolytic
What are the non-immunological transfusion reactions?
- Transmission of infectious disease
- Hypocalcaemia
- Circulatory overload
- bacteraemia
What is a haemolytic transfusion reaction?
It is a transfusion of incompatible or mismatched blood.
Describe an acute haemolytic transfusion reaction
- Acute intravascular haemolysis
- Activation of haemostatic system
- Hypotension
- Death
Describe a delayed haemolytic transfusion reaction
- Extravascular haemolysis
- 2-21days after transfusion
- negates the potential benefits of the transfusion
What does DEA stand for?
Dog erythrocyte antigens
What percentages of dogs are DEA 1.1 positive?
45%
T/F dogs can receive any blood type as their first tranfusion?
True - this is because dogs do not have antibodies to different blood types before they receive a blood transfusion.
How do cats differ from dogs when it comes to blood groups?
Cats differ from dogs in that they have naturally occurring alloantibodies. An incompatible transfusion will result in a haemolytic transfusion reaction, even if it’s the first time.
What is cross-matching used for?
It is used to detect the presence of antibodies to RBC’s
When do you use cross-matching?
- before blood transfusion in dogs
- When there is an unknown history
- When the long-term benefits of RBC transfusion are required
- In cats, if AB blood typing cards are unavailable.
What are the options for sourcing blood products for canines?
- buy canine products from blood bank.
- collect whole blood from donor dogs in the practice.
What are the options for sourcing blood products for cats?
Collect whole blood from donor cats in the practice.
What are the benefits of a blood bank?
- Blood products can be stored on-site for immediate use
- Products are tailored to individual needs
- Allowa for donation to be carried out in a calm and controlled setting
- Convenient for donor/donors owner
How should blood collection take place?
- 3 members of staff
- sterile scrub solutions, EMLA cream and clippers
- sedation in cats
- ideally pre-place catheter
- for dogs, use a human blood collection bag pre-filled with anticoagulant, scales for weighing the blood unit
- for cats, three 20ml syringes pre-filled with 2.6mls of anticoagulant
why, when taking blood donations, is the anticoagulant-to blood ratio crucial?
If there is too much anticoagulant, it can lead to citrate toxicity.
How much blood are you going to give for anaemia?
required volume = k x BW x ((disired PCV- recipient PCV)/ donor PCV)
How much plasma are you going to give for coagulopathies?
10-20mls/kg
How quickly should you administer the blood transfusion? start, hypovolaemic, normovolaemic and cardiac or renal patient.
- Start at 0.5-2ml/kg/hr for 30mins
Then - hypovolaemic = 20mls/kg/hr
- normovolaemic = 5-10mls/kg/hr
- cardiac or renal = 2mls/kg/hr
(Disorders of the equine lower respiratory tract)
What risk assessments should you take prior to doing an endoscopy on a horse?
- That horse can’t strike out, rear or leap forwards
- That you are not infornt of the horse
- Correct PPE
How should you restrain horse for an endoscopy?
- Twitch
- Stock
- sedation = Alpha 2 agonist and opioid = detomidine and butorphanol or romifidine and butorphanol
Why do tracheal secreations accumulate in horses?
Due to impaired mucociliary clearance mechanism
When doing an endoscopy on a horse and you see oedema of carina what may this indicate?
Suggestive of lower airway inflammation, particularly in severe equine asthma.
What can you do to sample lower resp tract?
- tracheal wash
- Bronchoalveolar lavage (BAL)
What can sampling of the lower resp tract in horses diagnose?
- Inflammatory disorders
- Haemorrhage
- Parasitic infections
- Neoplasia
Where does a tracheal wash collect secretions from?
The distal trachea
What are the two methods of tracheal wash?
- Trans-tracheal
- Trans-endoscopic
Describe how you would perform a Trans-Tracheal wash
- Sedation, sterile prep, local ana and a small incision
- Introduce catheter and long collection catheter
- 20mls saline in and then retrieved
What are the two different types of catheters you can use in trans-endoscopic tracheal wash?
- Single lumen for cytology
- Triple lumen catheter for cytology and microbiology
Describe how you would person and Trans-endoscopic tracheal wash
Before you reach the horizontal sump of trachea, instil 20mls of saline, then chase and retrieve saline at the sump.
T/F a trans-tracheal tracheal wash can be used for cytology and microbiology?
True
Where does a BAL collect respiratory secretions from?
The peripheral lung
What do the secretions from BAL provide information on?
- If diffuse lower resp tract pathology
- may miss focal pathology
What are the two methods of doing a BAL
- Blind BAL tube
- Via endoscope
Describe how a blind BAL works
- After tracheal wash use the catheter to deliver lidocaine at the carina
- Pass sterline BAL tube
- when horse starts to cough, instil more lidonocaine
- pass the tube till wedges then inflate the cuff
- instil warm fluid then retrieve
What can you use haematology and biochem to detect in horses?
- infectious disease
- Pneumonia
- kinda equine asthma
- parasitism
- neoplasia
- immunodeficiency syndromes
When does hyperpnoea start?
When the arterial oxygen pressure is less that 70mmHg
What is thoracocentesis useful for in horses?
- Total white cell count and protein concentraction
- cytological exam
- microbiological culture and sensitivity
What are the most common causes of pleural effusion in horses?
- Bacterial infection
- Neoplasia
what is equine asthma
describes all nonseptic lower airway inflammation
what is seen with mild to moderate equine asthma
chronic cough/ poor performance
lower airway inflammation
what is seen with severe equine asthma
lower airway inflammation
reversible obstruction
cough etc
what is severe equine asthma
adult horses with lower airway inflammation and obstruction associated with frequent coughing and increased resp effort at rest
how is severe equine asthma reversed
obstruction reversed by bronchodilators or environmental change
what is mild to moderate asthma
any age horse with chronic cough and/or poor performance
excess tracheobronchial mucous and/or increased ratio neutrophils, eosinophils and/ or mast cells in BAL fluid
what are the likely causes of severe equine asthma
stabling and/or feeding hay
moulds, bacterial endotoxins
irritants such as ammonia, cold air and dust
is severe equine asthma reversible or not
reversible
what is the pathogenesis of severe equine asthma
non-infectious LRT inflammatory disease
neutrophil influx into the airways
mucus accumulation
bronchospasm
bronchial hyper-reactivity
bronchiolitis, bronchiectasis, progressive fibrosis
who is predisposed to severe equine asthma
no apparent breed/ sex predilection
mature animals
signs are reversible in a low dust environment
what are the clinical signs of severe equine asthma
variable
mucoid nasal discharge
cough
exercise intolerance
increased expiratory effort
nostril flaring
tachypnoea
how do you diagnose severe equine asthma
history, clinical signs and physical exam
tracheal endoscopy
tracheal wash
BAL
evidence of obstruction
how do you diagnose evidence of obstruction in severe equine asthma
history
clinical signs
measurement (pulm function tests)
reversible by change of environment + administer anticholinergic
what are the goals of treatment of severe equine asthma
treat airway inflammation
relieve airway obstruction
prevent re-occurrence
what environmental management do you do with severe equine asthma
24 hr turnout
low dust housing
low dust feed
good ventilation
stable management - deep litter bedding, dampen all feeds, groom outside
forage/ straw store location
muck heap location
what pharmacological therapy can be used in horses with severe equine asthma
systemic=> easier to admin, risk of adverse effects
inhalational => initial set up expensive, efficacious, deliver high concs to airway, compliance
what are the aims of therapy in severe equine asthma
decreased inflammation
relieve bronchospasm
reduce bronchoconstriction
increased mucociliary clearance
decreased viscosity
stabilise mast cells
suppress immune system
what drugs are used to control airway inflammation in severe equine asthma
corticosteroids
systemic: prednisolone vs dexamethasone
inhalational: via metered dose inhaler or nebulised
what is the licensed inhaled corticosteroid in UK for severe equine asthma
aservo equihaler
what are the features of aservo equihaler
licensed in 2020
ciclesnoide is the active ingredient
anti-inflammatory therapy
decreases airway reactivity
improved pulmonary function
what two drugs are licensed for inhalation therapy in the UK for severe asthma
aerohippus - space chamber only
flexineb- nebuliser
what do bronchodilators do on severe equine asthma
relieve constriction of the bronchi
can be systemic or inhalational
what IV bronchodilator is given to horses with severe equine asthma
clenbuterol
when is clenbuterol indicated
severe cases with with resp distress in horses with severe equine asthma as they have reduced beta-2 adrenergic receptors
what are the side effects of clenbuterol in horses
sweating
mild colic
affects uterus= interfere with parturition
what inhaled bronchodilator is short acting in horses
salbutamol
what inhaled bronchodilator can be used long term in horses with severe equine asthma
salmeterol
features of salbutamol for horses
emergency relief or rescue drug
increase cortocosteroid deposition
<4x a week unless together with a corticosteroid
features of salmeterol in horses
long term control of SEA
duration 6-8hrs
use with corticosteroid
what other bronchodilators can be given to provide smooth muscle tone
ipratropium- inhaled
atropine- systemic
buscopan- systemic
What other medications other than bronchodilators should you consider giving to a horse with severe equine asthma
antibiotics
mucolytics
expectorants
mast cell stabilisers
what treatment should you do for severe equine asthma in a horse who has a less than desirable environment/ feeding practice
change environment/ feeding
no treatment or just oral clenbuterol may be sufficient
reserve further treatment for non-response
what treatment should you give a high performance horse or environment/ feeding alterations are less obvious or no response to above or more aggressive treatment warranted
further investigation
oral clenbuterol for 2 weeks or inhaled beta-2 agonists combined with longer term inhaled or systemic corticosteroids
can you clinically distinguish between severe equine asthma and summer pasture associated-severe equine asthma
NO
what aeroallergens cause summer pasture associated severe equine asthma
seen at pasture
allergy to flower/ crop/ tree/ grass pollens and moulds
seen in summer/ autumn
what treatment should you give for summer pasture associated - severe equine asthma
use of corticosteroids during expected periods of challenge
what is seen during acute exacerbations of summer pasture associated- severe equine asthma
dyspnoea and cyanosis
usually on hot humid summer evenings
what drug can you give during acute exacerbations of SPA-SEA
atropine
what horses is mild to moderate asthma normally seen in
young athletic horses
what are the clinical signs seen with mild to moderate equine asthma
exercise intolerance/ poor performance
coughing
increased resp secretions
no increased resp effort at rest but seen at exercise
what is the aetiology of mild to moderate equine asthma
environmental dusts/ organic particles/ gases
bacteria/ viruses
genetics, immune status
exercise induced pulmonary haemorrhage
how do you diagnose mild to moderate equine asthma
history and clinical exam
rebreathing bag test
endoscopy
cytology (BAL)
pulmonary dysfunction
pulmonary hypersensitivity
what would be seen on a positive diagnosis of mild/ moderate equine asthma on cytology
neutrophilia
moderate inflammation 5-20% of differential count
some may have increased eosinophils and mast cells
what treatment would you use on mild/ moderate equine asthma
low dust environment
corticosteroids- IV or inhaled, possibly in combination with bronchodilators
how do you know that the horse is responding to treatment of mild/moderate equine asthma q
subclinical so need to repeat BAL to confirm
how do you prevent mild/ moderate equine asthma in young horses
low dust environment
good ventilation
what is the differentiation in signalment of MEA and SEA
MEA= usually young adults
SEA = >7 years
what is the differentiation in clinical signs of MEA and SEA
MEA= no dyspnoea at rest but may have tachypnoea
SEA= dyspnoea at rest
what is the differentiation between diagnostic testing results in MEA and SEA
MEA- less marked airway inflammation
hay challenge= SEA demonstrate increased resp effort
what is the differentiation in prognosis of MEA and SEA
MEA= short duration, can resolve spontaneously or with treatment, low risk of recurrence
SEA= long duration, recurrent
what is the possible pathogenesis of exercise induced pulmonary haemorrhage
stress failure of pulmonary capillaries
assc. with MEA
low alveolar pressure
upper airway obstruction
mechanical forces assoc. with locomotion
what are the presenting signs of exercise induced pulmonary haemorrhage
none
+/- post exercise/ race epistaxis
+/- poor performance
+/- repeated swallowing post exercise/ race
+/- prolonged recovery post exercise/ race
what are the clinical signs of exercise induced pulmonary haemorrhage
none
+/- epistaxis
+/- abnormal lung sounds
how do you diagnose exercise induced pulmonary haemorrhage
endoscopy 30-60 mins post exercise
BAL cytology
what would be seen in BAL cytology of a horse with exercise induced pulmonary haemorrhage
free red blood cells
haemosiderophages
+/- neutrophils
what does treatment of exercise induced haemorrhages aim to do
reduce haemorrhage
minimise sequelae (inflammation and fibrosis)
what treatment do you give for exercise induced pulmonary haemorrhage
rest for 2-4 weeks
address LRT inflammation
altered training
frusemide before fast exercise but not before racing in UK
what is interstitial lung disease an acute or chronic inflammatory process of
primarily alveolar walls and adjoining bronchiolar interstitium
what does acute interstitial lung disease present as
acute respiratory distress
what does chronic interstitial lung disease present as
SEA
what are the causes of interstitial lung disease
multifactorial
toxic agents
infectious agents
idiopathic
how do you diagnose interstitial lung disease in horses
process of elimination and radiography
what is equine multinodular pulmonary fibrosis
an emerging subset of interstitial lung disease
what signalment of horse are most affected with equine multinodular pulmonary fibrosis
older horses
what clinical signs are seen with equine multinodular pulmonary fibrosis
tachypnoea and tachycardia
weight loss
pyrexia
how do you diagnose equine multinodular pulmonary fibrosis
differentiate from severe equine asthma
differentiate from infectious pneumonia
BAL samples
radiography
ultrasonography
what would be seen on radiography of equine multinodular pulmonary fibrosis
diffuse nodular interstitial pattern
what would be seen on ultrasonography of equine multinodular pulmonary fibrosis
diffuse pleural thickening
may identify nodules superficial on lung
biopsy
how do you treat equine multinodular pulmonary fibrosis
dexamethasone, doxycycline, acyclovir
what species of equid get dictylocaulus arnfieldi
donkeys. mules and horses
are donkeys and mules symptomatic or asymptomatic carriers of dictylocaulus arnfieldi
asymptomatic reservoirs of infection
what is seen in horses with dictylocaulus arnfieldi
chronic cough
increased resp effort
wheeze/ crackles on auscultation
how do you diagnose dictylocaulus arnfieldi in horses
BAL cytology
may see larvae in tracheal wash
few eggs in faeces as usually not patient infection in horses
how do you treat dictylocaulus arnfieldi in horses
oral ivermectin/ moxidectin
Features of parascaris equorum
relatively minor
3 months to become patent infection
larval migration in foals/ yearlings
what clinical signs are seen with parascaris equorum
lung inflammation and clinical signs
small intestinal obstruction/ intussusception
ill thrift and diarrhoea
how do you diagnose parascaris equorum
FWEC when patent infection
How to you treat/ prevent parascaris equorum
deworming
what is bacterial pneumonia/ pleuropneumonia
bacterial infection of the lung parenchyma
bronchopneumonia, with or without the involvement of the pleural space
what is the aetiology of bacterial pneumonia in horses
bacterial from nasal or oropharynx
what are the gram +ve causative bacteria in bacterial pneumonia
strep equi
staph aureus and pneumoniae
what are the gram -ve causative bacteria in bacterial pneumonia
actinobacillus and pasturella spp.
e.coli
klebsiella pneumoniae
bordetella bronchiseptica
what are the common obligate anaerobes in bacterial pneumonia
bacteroides fragilis
fusobacterium or clostrisal spp.
what does the pathogenic development of pneumonia require
overwhelming bacterial challenge
impairment of pulmonary defences
what are the presenting signs of bacterial pneumonia
pyrexia
inappetence
signs of depression
cough
exercise intolerance
nasal discharge
tachypnoea
hypopnoea
resp distress
what would you see systemically on a clinical exam of a horse with bacterial pneumonia
evidence of systemic inflammatory response syndrome
tachycardia
mucous membranes
laminitis
what would you find on auscultation of a horse with bacterial pneumonia
exudate in trachea
increase insp noise with wheezing and crackles ventrally
reduced breath sounds ventrally
how do you diagnose bacterial pneumonia in horses
history + clinical signs
haematology and biochem
endoscopy
tracheal wash
diagnostic imaging
thoracocentesis
what would be seen on ultrasonography of a horse with bacterial pneumonia
comet tails
lung consolidation
abscesses
pleural fluid, fibrin etc
what antimicrobials would you give first line to treat bacterial pneumonia
penicillin + gentamicin +/- metronidazole
depending on sensitivity consider - oxytetracycline, ceftiofur, enrofloxaxin
what other supportive treatment can be given to horses with bacterial pneumonia
bronchodilation
NSAIDs
remove pleural fluid - esp if in resp distress
supportive care- fluids, good ventilation, low dust environment, no stress
what should you monitor for horses with bacterial pneumonia
clinical exam
haematology
acute phase proteins
tracheal endoscopy +/- tracheal wash
ultrasonography
what complications are seen with bacterial pneumonia and pleuropneumonia in horses
abscess formation
pleural adhesions/ abscess
with pleuropneumonia:
cranial mediastinal mass/ abscesses
laminitis
bronchopleural fistula
thrombophlebitis
pneumothorax
pulmonary necrosis
what are most cases of bacterial pleuropneumonia an extension of
bacterial pneumonia
pulmonary abscess
trauma
oesophageal rupture
what is seen with severe acute pleuropneumonia
tachycardia, toxic mucous membranes- SIRS
pleural friction rubs on auscultation
pleural pain= shallow breathing, colic signs, pain on palpation of thorax
what is seen with chronic pleuropneumonia
intermittent fever/ weight loss
what causes lung collapse in pneumothoraxes
pleural pressure equilibrates with atmospheric pressure
how do you diagnose pneumothorax in horses
ultrasonography
radiology
what is the treatment for an open pneumothorax
seal wound with plastic sheet or surgical closure
remove air via trocar
what is the treatment for a closed pneumothorax
remove all air via trocar until source of entry found
discuss bacterial pneumonia in foals
3 weeks - 6months of age
acquire by inhalation
can be insidious but progress to acute resp distress and death
how do you diagnose bacterial pneumonia in foals
auscultation
haematology and biochemistry
ultrasonography/ radiography
TW culture and cytology
what is the treatment for bacterial pneumonia in foals
antimicrobial needs to have high Vd
long duration 4-9 weeks
rifampin + macrolide
supportive therapy
what are other causes of pleural effusion
thoracic neoplasia
congestive HF
thoracic trauma
hypoproteinaemia
coagulopathy
chylothorax
what changes within vessels cause pleural effusions
increased permeability in capillary vessels
increase in hydrostatic pressure
decrease in oncotic pressure
decrease in fluid removal
what are causes of increased permeability on capillary vessels
infection
inflammation
neoplasia
what causes an increase in hydrostatic pressure
congestive heart failure
portal hypertension
what causes a decrease in oncotic pressure
hypoproteinaemia
what causes a decrease in fluid removal from vessels
impaired lymphatic drainage or obstruction
pleural or parenchymal infiltration
what are the 4 main neoplasia found in equine thoraxes
lymphoma
mesothelioma
pulmonary granular cell tumour
metastatic neoplasia
features of lymphoma neoplasia in the thorax of a horse
more common in young adult horses’
rarely leukaemic
most common neoplasm in the thorax
- primary thoracic neoplasia, often cranial mediastinal mass and associated with pleural effusions
what are lymphoma neoplasms in the thorax normally classified as
multicentric
alimentary
cutaneous
mediastinal
is a mesothelioma commonly a primary or secondary thoracic tumour in horses
primary
what might pulmonary granular cell tumours be misdiagnosed as due to the clinical signs associated
SEA
what are the common metastatic neoplasias in equine thoraxes
adenocarcinomas
melanoma
hemangiosarcoma
squamous cell carcinoma
how do you calculate the allowable blood loss in cattle
(estimated BV x(initial PCV- MInimum PCV))/ initial PCV
what is the BV of a cow
55ml/kg
what are the common haemorrhages seen in cattle
epistaxis with caudal caval syndrome
ruptured middle uterine artery
trauma to udder and mammary vasculature
what MM are the most reliable in cattle
ocular conjunctival or vulval
what is the most common fluid given to cattle in fluid rescue
hypertonic saline
do you need to cross match before cattle blood transfusions?
No
How much blood can you easily take from a donor cow
8-10 litres
why might future neonates be affected if their mother is given a blood transfusion
mother will make antibodies against that blood group-> neonates become sensitive to the blood groups
what factors are contributing to the change in distribution of different infectious causes of anaemia
changes in climate
changes in distribution of vectors
what are the methods to diagnose hemoparasites in cattle
giemsa stained smears
microscopic examination
pathogen-specific PCR or qPCR
what can fleas cause in calves kept in warm wet environment
severe anaemia and death
what can haemaphysalis longicornis cause throughout asia and oceania in cattle
acute, severe and fatal anaemia
can rhipicephalus microplus be fatal in cattle
yes in exceptional circumstances
what can haematobia irritans irritans and H iexigua cause in cattle
production loss
what diseases do ixodes ricinus carry
babesia divergens
anaplasma phagocytophilum
louping ill
what diseases do dermacentor reticulatus carry
babesia spp.
anaplasma marginale
what diseases do rhipicephalus microplus carry
babesia bigemina
babesia bovis
anaplasma marginale
what diseases do rhipicephalus microplus and rhipicephalus decoloratus carry in africa
babesia bigemina
babesia bovis
anaplasma marginale
what diseases do amblyomma variegatum and amblyomma hebraeum carry in africa
ehrlichia ruminantium
heartwater
what diseases do rhipicephalus appendiculatus carry
theileria parva
what diseases do hyalomma spp. carry
theileria annulata
what is the treatment for babesia
imidocarb dipropionate
what are the clinical signs of tsetse and trypanosomes
anaemia
ill thrift
pyrexia
lymphadenopathy
haemorrhagic syndrome
death
how do you control tsetse and trypanosomes
habitat distruction
game reduction
aerial spraying
insecticide treatment of cattle
drug treatment of cattle
traps/ targets
what drugs can be used against trypanosomiasis
isometamidium
homidium bromide
diminazine aceturate
what is the epidemiology of enzootic haematuria
low morbidity but mortality can be high
only seen in older mature cattle
what is the pathogenesis of enzootic haematuria
ptaquiloside-> bladder wall thickening, metaplasia, formation of carcinomas
what are the clinical findings of enzootic haematuria
intermittent mild haematuria
gradual loss of condition
palpable thickening of the bladder wall on rectal examination in advanced cases
what is the aetiology of acute bracken fern poisoning
toxic principal in brachen, mulga and rock fern
young fronds more toxic
underground rhizomes highly toxic
what is the epidemiology of acute bracken fern poisoning
low morbidity but very high mortality
younger animals
seen when other feed scarce
requires ingestion of large amounts
what is the pathogenesis of acute bracken fern poisoning
radiomimetic effect on bone marrow causing thrombocytopenia and leukopenia
what are the clinical signs of acute bracken fern poisoning in cattle
pyrexia
inappetance
depression
blood in faeces and urine
haemorrhages in MM
fibrinous broncho-pneumonia
young calves= brachycardia and laryngeal oedema
what are the PM findings of acute bracken fern poisoning
haemorrhaemorrhages in all tissue
free blood in intestinal lumen
secondary infectious processes
what are the inherited disorders of the erythron in cattle (bos taurus)
bleeding diathesis
bleeding disorder
factor XI deficiency
haemophilia A
haemolytic anaemia
spherocytosis
thrombopathia
do hot or cold blooded horses have more erythrocytes
hot
do hot or cold blooded horses have a lower volume/kg
cold
are immature RBC released into the circulation in horses
no
are there reticulocytes in regenerative anaemia of horse
no
what might affect haematology of horses before taking their blood
exercise
feeding
travel
stress
what are clinical signs of acute blood loss in horses
tachycardia
tachypnoea
hyperpnoea
MM colour depends on severity of loss
What are clinical signs of chronic blood loss
exercise intolerance
weight loss
pallor of MM
adaptive tachycardia at <20l/l
haemic murmur due to decreased viscosity and increased turbulence
how do you know if the anaemia is regenerative in horses
sequential samples for PCV and TSO with constant sampling conditions
how long does it take albumins to recover after haemorrhage in horses
5-10 days
how long does it take globulins to recover after haemorrhage in horses
3-4 weeks
what is a good sampling site on horses after haemorrhages
facial venous plexus
what diagnostic tests can you do in anaemic horses
strong red cell rouleaux formation
equine platelets clump in EDTA specimens
test for genuine autoagglutination
what are specific infectious disease tests to consider in horses
equine infectious anaemia
equine piroplasmosis
equine ehrlichiosis
equine trypansomosis
where do you collect bone marrow from for evaluation in horses
Equine sternum with jamshidi needle
what is the normal myeloid:erythroid ratio in bone marrow of horses
0.5-2.4
what does a <0.5 M:E ratio with >5% reticulocytes indicate in horses
adequate regenerative response to anaemia
when would IMHA not be regenerative in horses
if precursor cells are targeted
what are the ways of acute blood loss in horses by trauma or surger
intraabdominal
intrathoracic
arterial laceration
what are the ways of acute blood loss in horses by the resp system
epistaxis
exercise induced
pulmonary artery rupture
what are ways of acute blood loss in horses via the GIT
mesenteric tear
strongylus vulgaris arteritis
what are ways of acute blood loss in horses via the urinary tract
renal haemorrhage
what are ways of acute blood loss in horses via the uterus
uterine artery rupture
foaling complications
what % loss is required before collapse in a horse with acute haemorrhage
20-30%
how much blood does a horse have
80-100ml/kg
what is an indicator that transfusion is required in horses
hyperpnoea caused by hypercapnia/ hypoxaemia
how many blood groups do horses have and what are they
7
A, C, D, K, P, Q, and U
What group is the best donor group of horses
AaCa +ve blood group
how do you cross- match blood transfusions
tube agglutination of washed red cells is standard for major and minor cross matching
how do you collect equine blood for transfusions
donor must be -ve for piroplasmosis and other blood borne infections
12G catheter placed upwards in jugular after sterile prep
how much blood can you collect from a horse
1L/ 100Kg
what is the cost common anticoagulant for horse blood collection
acid citrate dextrose
how do you administer blood transfusions to a horse
via filter containing blood transfusion set
up to 15 ml/kg
1 drop/ 5s for first 5 mins then increase
How much blood is required in a horse with acute haemorrhage
BW(Kg) x 80 x desired PCV- (recipient PCV/ donor PCV)
what are ways of chronic blood loss in horses via the GIT
gastric ulceration
severe colitis
strongylus vulgaris arteritis
what are ways of chronic blood loss in horses via resp system
exercise induced pulmonary haemorrhage
epistaxis
what are ways of chronic blood loss in horses via the urinary system
renal haemorrhage
bladder haemorrhage
what are ways of chronic blood loss in horses via coagulopathies
thrombocytopaenia
factor VIII deficiencies
what investigations can be done for chronic GIT blood loss in horses
gastroscopic exam
faecal egg count
what investigations can be done for chronic resp blood loss in horses
endoscopy + cytology
urine sediment cytology
what investigations can be done for chronic urinary blood loss in horses
assess accurate platelet count
what investigations can be done for chronic coagulopathies in horses
measure PT and PTT times
assess hepatic function
assay factor VIII conc
what will be seen on haematology if the chronic haemorrhage has stopped and is regenerating
increased PCV, TSP and MCV
features of primary immune-mediated haemolytic anaemia in horses
less common form
+ve coombs test
increased erythrocyte fragility
osmotic fragility test more useful than coombs
features of secondary IMHA in horses
what are the causes of secondary IMHA
resp tract infections
streptococcal abscesses
drug induced
neoplasia
how do you treat IMHA
identify & discontinue suspect medications
dexamethasone if severe haemolysis
blood transfusion from compatible donors if clinical evidence of requirement
rate of blood loss
what is neonatal isoerythrolysis
immune mediated haemolysis due to RBC ag incompatibility
what clinical signs are seen with neonatal isoerythrolysis
anaemia
icterus
weakness
inc RR
tachycardia
pale MM
how do you diagnose neonatal isoerythrolysis
clinical signs
haematology
rule out DDx
immunological testing
foal RBCs and mare serum/ colostrum
what is the treatment for neonatal isoerythrolysis
supportive care
blood transfusion from a suitable donor
how do you prevent neonatal isoerythrolysis
check blood compatibility before mating
immunological testing
prevent nursing for 24hrs in at risk foals as no Abs are passed transplacentally
give alternate source of colostrum
what makes a foal more predisposed to neonatal isoerythrolysis
a mother who has already had foals and prior mare-stallion incompatibility
what causes non-regenerative anaemia in horses
iron deficiency
chronic diseases
bone marrow failure
coagulopathies
miscellaneous i.e. chronic hepatic + renal disease
what should you investigate when searching for haemorrhage in a horse with non-regenerative anaemia
gastroscopy examination
faecal egg count
endoscopy + cytology
thorax and abdominal US
urine sediment cytology
what should you assess on a coag profile in a horse with non-regenerative anaemia
assess accurate platelet count
measure PT and PTT times
citrate blood tubes
assay factor VIII concs
what should you assess in the metabolic function of a horse with non-regenerative anaemia
assess hepatic function
measure renal function
an inflammatory response?
are acute phase proteins
what is anaemia of chronic disease in horses
shortened erythrocyte lifespan
decreased release of iron
decreased bone marrow response to EPO
what clinical signs are seen with anaemia of chronic disease
pleuropneumonia
internal abscessation
peritonitis
chronic parasitism
neoplasia
what are 3 causes of inadequate erythropoiesis
nutritional deficiencies
myelophthisic anaemia
bone marrow aplasia
what causes nutritional deficiencies that cause inadequate erythropoiesis
prolonged administration of sulphonamides causing decreased folate and vit B12 production by GIT flora
how do you determine if myelophthisic anaemia is the cause of inadequate erythropoiesis
bone marrow aspirate/ biopsy required
cytology and M:E ratio assessed
what is seen with bone marrow aplasia causing inadequate erythropoiesis
neoplastic infiltrate detected on bone marrow aspirate from sternum
likely to have pancytopenia with decreased neutrophils & platelets
least common form
what is seen on blood analysis of acute blood loss anemia
low PCV, Hb and low TSP
what is seen on blood analysis of haemolytic anaemia
low PCV, normal TSP, increased unconjugated bilirubin, increased MCHC, haemoglobinuria
what is seen on blood analysis of chronic disease induced anaemia
low PCV, low Hb, high TSP
may be inflammatory leukogram with increased APPs
may be reduced ferritin and high TIBC
what is equine piroplasmosis
tick-borne haemoprotozoan parasites
what are the 3 kinds of tickborne parasite that cause equine piroplasmosis
theileria equi
babesia caballi
how are theileria equi parasites transmitted
intrastadial and transstadial
when do clinical signs of theileria equi appear
12-19 days after infection
how are babesia caballi transmitted to horses
intrastadial, transstadial and transovarian transmission
when do clinical signs of babesia caballi appear
10-30 days after infection
what is the pathogenesis of equine piroplasmosis
release of merozoites cause haemolysis of RBC
-> decreased survival of non infected red cells
microthrombi and vasculitis
thrombocytopenia is often seen
SIRS and progression to MODS
what can transplacental transmission of theileria equi cause
abortion
neonatal piroplasmosis
where is equine piroplasmosis found
endemic in central and south america, africa, asia, middle east and southern europe
increasing presence in northern europe
what are the risks of equine piroplasmosis to the UK
free movement of horses between UK, france and ROI without border inspection
no specific guidelines re pre import tick treatment
no requirement to test horses moving within EU
tick species likely to be capable of transmission present in UK
what are the clinical signs of acute piroplasmosis
pyrexia, lethargy and haemolysis
systemic signs depend on level of haemolysis= tachycardia, tachypnoea and weakness
petechiations + marked thrombocytopenia
concurrent disease exacerbates
multiple possible causes
immune complexes attach to RBC
disease alters RBC membrane
antigen cross reacting
drug interaction
