SA Immune Diseases Flashcards
how common are inherited neutrophil defects?
very rare
how common are aquired neutrophil defects?
very common
are innate or adaptive immune system deficiencies more common?
adaptive
what is the most common inherited adaptive immune deficiency?
decreased Ab production due to decreased B cell function or lack of B cells
what are the most common causes of acquired adaptive immune deficiencies?
Steroid therapy
Cushings
Diabetes Mellitus
what diagnostics can you do to see initial clues of immune deficiencies?
history and CBC
is IMHA usually primary or secondary?
primary
classic CBC findings of IMHA
regenerative anemia
spherocytes
agglutination
biochem findings of IMHA
hyperbilirubinemia
Diagnostics for IMHA?
which is more specific?
Coomb’s test - direct anti-globulin test (detects IgG bound to RBC)
flow cytometry for RBC Ab (more specific)
what is PIMA?
precursor targeted immune mediated anemia
CBC findings of PIMA
non-regenerative anemia
no spherocytes
no agglutination
will the Coombs test be - or + with PIMA?
negative
Diagnostics for PIMA?
bone marrow aspirate and cytology
steroid trial
diagnostics and treatment for PIMA?
bone marrow aspirate + cytology
steroid trial
most common causes of death in dogs with IMHA?
anemia
thromboembolism
how can you prevent thromboembolisms in patients with IMHA?
unfractionated heparin
low molecular weight heparin
clopidogel
what are the three differentials for severe thrombocytopenia?
immune destruction
consumption
decreased production
best diagnostic test for IMTP
flow cytometry for anti-platelet antibodies (APA)
what is the mechanism of immune mediated neutropenia in dogs?
anti-neutrophil cytoplasmic antibodies (ANCA)
what would you expect to find in a joint tap with polyarthritis?
95% non-degenerate neutrophils
supportive, non-septic inflam
diagnostics for immune mediated neutropenia in dogs?
bone marrow aspirate and cytology
key abnormalities for systemic lupus erythematosus
cytopenias
polyarthritis
proteinuria
diagnostics for systemic lupud erythematosus?
antinuclear Ab (ANA)
joint taps
UPC
CBC
is prednisone or dexamethasone more potent? which has a longer half life?
dexamethasone
Mycophenolate
MOA:
side effects:
purine synthesis inhibitor - blocks T cell proliferation
GI - vomiting, diarrhea
Azathioprine
MOA:
side effects:
purine production & DNA synthesis inhibitor - blocks T cell proliferation
hepatotoxicity (idiopathic hepatic necrosis)
Leflunomide
MOA:
side effects:
pyrimidine synthesis inhibitor - blocks T cell proliferation
GI toxicity, vasculitis
Cyclosporine
MOA:
side effects:
blocks cytokine production
GI toxicity in dogs, nephrotoxicity in cats
Oclacitinib (Apoquel)
MOA:
indications?
side effects?
Jax inhibitor = blocks signaling when cytokines bind to target cells
adjunct therapy in autoimmune disease
GI and bladder infection
Intravenous Immune Globulines
toxicity?
anaphylactic reactions
steroid physiologic/replacement dose
0.05-0.1 mg/kg/day
steroid anti-inflam dose
0.25 - 0.5 mg/kg/day
steroid immunosuppressive dose
1-2 mg/kg/day
how should you initially treat an immune disease?
high dose steroids (2mg/kg/day)
+ T cell targeted drug (cyclosporine, mycophenolate)
after clinical remission, taper steroids first (50% dose reduction)
how should you treat refractory immune disease cases?
rescue therapies
- high dose methylprednisolone (10-30 mg/kg/day)
- addition of oclacitinib (apoquel)
- splenectomy
when should you begin to taper steroids? by how much?
full clinical remission
50% dose reduction of steroids
later taper T cell drugs
