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48 Cards in this Set

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IMHA/ ITP
type II hypersensativity
Ab against cell or cellular constituents (cell surface, cell receptor)
IMHA immunological process
activation of self directed Ab =viral/ bacterial infection triggers immune dysregulation (primary)
Innocent bystander= Ab directed against infectious agent or drug that is assoc with cell surface (secondary)
Clinical presentation of IMHA/ ITP: intravascular
fever, complement mediated, ACUTE ONSET, hemogobinuria, hemoglobinemia, weakness, anorexia, vomiting, anorexia, diarrhea, pallor, NON- REGEN (too early, need 1-3 days for BM to work)
Clinical presentation of IMHA/ ITP: extravascular
fever, removel by RE sysem, SUBACUTE ONSET, weakness, anorexia, ICTERUS, pallor, SPLENOMEGALY, REGEN (bone marrow already working)
AIHA
primary immune mediated hemolytic anemia,
IMHA/ IHA
may be primary or secondary
Evan's syndrom
IMHA and ITP (usually primary)
IMHA class I
autoagglutination (clumping of RBC after binding by Ab)
intravascular hemolysis
IMHA Class II
intravascular hemolysis
IMHA class III
extravascular hemolysis
SPEROCYTE
MOST COMMON FORM IN DOG
IMHA class IV
Cold agglutination
intravascular hemolysis
IMHA class V
extravascular agglutination under cold condition
Warm IMHA signs
depression, lethargy, weakness, syncope (loss of conciousness, fainting)
pale mm, icterus
spleno- hepatomegaly
lymphadenopathy
PYREXIA (fever)
vomiting
PTE (pulmonary thromboembolism(
DIC (disseminated intravascular coagulaiton)
Cold IMHA sign
CYANOSIS, necrosis, gangrene
on ear tip, nose, tail, distal extremities
IMHA- primary
most common in dog
may be assoc with infection
SLE
idiopathic
IHA- secondary
most common in cats
drugs (methimazole, pencillin, sulfonamide, procanimide, cephalosporin)
neoplasia
rickettsia dz
mycoplasma haemofelis
Babesia
Cytauzoonosis
lepto
VX
zinc- pennies, bolt
toxin
signalment of IMHA
any dogs or cats
any age
Female> male
2-7 yr most common
breed predisposed: american cocker, english springer spaniel, old english sheep dog, irish setter, poodle, german shepard
Ddx of IMHA- min database
min database
CBC- HCT/ PCV retics count, SPHEROCYTOSIS
chem panel- incr. liver enzyme, increase bilirubin
UA- intravascule- hemoglobinuria and proteinuria, extravascular- bilirubinuria (cause icteric)
Specific test for ddx IMHA
slide agglutination
COOMB'S TEST- only if slide agglut. test neg
should consider cross match
test for possibel causes- rads, tick panel(rickessial), FeLV, FIV
Agglutination test
place a drop of EDTA blood on a slide
examine at RT and 4 degree C
Bone marrow assesment ( Diag test for IMHA)
unnecessary w/ regen anemia
erythroid hyperplasia indicate refen
myelofibrosis (replacement of BM w/ fibrous tissue)C or RBC aplasia seen with nonregen
Coomb's test0 diag test for IMHA
Direct Coomb's test- detect IgG, IgM or C3 bound to RBC
combine whole blood with species specific agent and look for agglutination
False +ve Coomb's test
recent transfusion
False -ve Coomb's test
Ab vs. precurson not cell
drug dependant
steroid admin
Indirect Coomb's test
invalid, detects Ig og C bind to exogenous RBC/ Ag complex
direct enzyme linked antiglobulin test
ELISA
detects Ig bound to RBC
Direct immunofluorescence
flow cytometry
detects Ig bound to RBC
ANA
detect IG bind to nuclear component
Test for underlying etiology
serology, culture
test FeLV
Treatment goal for IMHA
stop hemolysis
maintain tissue oxygenation
provide adequate perfusion
manage potential side effect
Stop hemolysis
1. glucocorticoid- PU/PD, weight gain, hair loss, iatrogenic cushingss
2. azathiprine- $, NOT IN CATS
3. Cyclosporin- $$$$
4. If doesn't work- IV human Ig- $$$
5. cyclophosphamide and splenctomy not demonstrated to have benefit
Tissue oxygenation
maintain adequate tissue oxygenation while waiting for response
1. plasma RBC transfusion
Adequate perfusion
prevent sludging of blood
decrease organ damage and risk of DIC
IV FLUIDS
Prevent side effect
Thromboembolism (clot in blood vessel) and DIC
low dose asprin (best evidence)
low molecular wt heparin (some evidence)
unfractionated heparin (not proven)
Prognosis
decrease albumin- bad
incr bilirubin- bad
age- older, bad
RESPONSE TO THERAPY (most impt), continue autoagglutination bad, need to add meds to get it under control
Aftercare for IMHA
gradually tapered meds (pred 1st cause of side effect)
recheck PCV q 7-14 days initially and then 4-6wks
even after off meds, need CBC q 6-12 m for life
AVOID INITIATING CAUSE
ITP (Idiopathic thrombocytopenic purpura)
Primary: SLE, idiopathic
Secondary: HW, neoplasia, lepto, FeLV/ FIV/ FIP, modified live vx, leishmania, mycoplas,a haemoflis, Ehrlichiosis, Rickettsia, Babesia, Cytauxzoon, drugs
Signalment- similar to IHA
any dog or cat
any age but F>M
2-7 yr most common
breed (american cocker, english springer spaniel, english sheep dog, german shepard, poodle)
Clinical presentation
Petechiae
ecchymosis (bruise)
hyphema
epistaxis- unilateral or bilateral
fever
lethargy
GI bleeding- melena (black tarry stool) and hematechezia (frank blood stool)
Ddx of ITP
CBC: throbocytopenia, incr. # of giant platelet
serum chem
coag test to evaluae DIC
tick titer
imaging for neoplasia
check vx and drug history
Diagnostic test- IMT
platelet Ab testing
serology (tick titer)
Chem, UA, rads, US, culture, PCR, ANA
Tx goals for ITP
stop platelet destruction
reduce blood loss
maintain tissue oxygenation if bleeding severe
provide adequate perfusion
To stop platelet destruction
1. glucocorticoid
2. Azathioprine (not in cats)
3. Cyclosporin
4. Intrvenous human Ig
5. cyclophosphamide and splenectomy not demonostrated benefits
Reduce blood loss
cage rest to reduce trauma
GI protectant (sucralfate, famotidine)
minimize venipunture and avoid large veins
minimize other percutaneous procedures (think b4 aspirating the LN)
Maintain tissue oxygenation
tranfusion if needed (whole blood if possible)
monitor for development of IHA
Adequate perfusion
IV fluids
blood pressure
Can we give platelets?
questionable platelet functions and limited availability
Prognosis o ITP
70% responsive to tx
poorer prgonosis if pt has Evan's dz (IMHA and ITP) or severe blood loss
25% recurrece rate