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157 Cards in this Set
- Front
- Back
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What's the commonest cause of hemolysis in dogs?
Is this common in cats? |
IMHA
no |
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What type of hypersensitivity reaction is IMHA considered?
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type II (cytotoxic)
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Do dogs get primary or secondary IMHA?
Cats? |
Dogs primary (idiopathic)
Cats secondary |
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What are causes of secondary IMHA?
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Drugs
Neoplasia Infection Vx Zinc Toxin |
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What is a common cause of zinc toxicity in pets?
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ingesting a penny
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Immune mediated disease...what's the signalment?
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middle aged female dog (eg Cocker)
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Which type of cell do we have to look for on blood smear if we suspect IMHA?
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spherocytes
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Which infections are associated with secondary IMHA?
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*Bartonella
*Mycoplasma haemofelis HW FeLV/FIV Rickettsial diseases Babesia Cytauxzoonosis Lepto |
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T/F IMHA is characterized by an insidious onset of CS.
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False--acute or peracute
"The dog is fine in the morning then really bad when the owner gets home from work." |
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On PE, what are some CS of IMHA?
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pale mm (anemia)
tachypnea/tachycardia (anemia) Icterus (IV hemolysis) petechiae/ecchymosis (ITP) Splenomegaly (extramedullary hematopoiesis) Murmur (PCV 18-21% --> low viscosity murmur) |
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What is Evan's Syndrome?
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when an animal has IMHA AND ITP...this is not good
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What are CS of ITP?
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petechiae & ecchymoses; oozing from mucous membranes; oozing after venipuncture
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Why might splenomegaly occur with IMHA?
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due to extramedullary hematopoiesis
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Why are RBCs hemolyzed with IMHA?
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because the dog's Ab are attacking htem and signaling the body to remove them prematurely
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What part of the body removes IMHA RBCs?
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the mononuclear-phagocytic system (spleen, liver, BM)
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Why might a dog get icteric if he had IMHA?
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from the intravascular hemolysis (leading to too much indirect bilirubin)
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What is a leukomoid reaction?
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when the bone marrow is so overstimulated to pump out RBCs that it shoots out the immature WBCs that are in there too (band cells, aka left shift)
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Which hepatic enzyme may be elevated with IMHA. Why?
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ALT due to liver hypoxia due to anemia and poor oxygen perfusion to tissues
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What are two RBC parasites we should screen for if an animal is suspected to have IMHA?
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Bartonella
Mycoplasma haemofelis |
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What are the three blood tests you could perform to diagnose IMHA?
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slide agglutination
Coombs Antinuclear Ab test |
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T/F Hyperbilirubinemia is a negative prognostic indicator for IMHA.
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True
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How do you perform slide agglutination test?
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Put 5-10 drops of RBCs from your EDTA tube on a slide.
Add some saline. |
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You do a slide agglutination test and the RBCs stay clumped. Diagnosis?
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probably IMHA
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You do a slide agglutination test and the RBCs separate. Diagnosis?
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could still be IMHA. Do a Coombs test.
Or, those clumps may have just been Roleaux formation |
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Explain a Direct Coomb's test.
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You take the patient's Ab-coated RBCs from the EDTA tube. Add anti-dog Ab to it. See how many dilutions it takes to prevent clumping... = titer. This should be performed at room temperature!!!!!!!!
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What might urinalysis of a dog with IMHA reveal?
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Hburia
proteinuria bilirubinuria |
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When does bilirubinuria occur--with intra or extravascular hemolysis?
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extravascular
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Is bone marrow assessment necessary in an IMHA patient?
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no
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Why is bone marrow assesment unnecessary in IMHA positive patients?
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BM analysis is unnecessary with regenerative anemia...if the BM is pumping out new RBCs then it's working.
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If you did a BM assessment of an IMHA patient what would you see?
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erythroid hyperplasia....indicates RBC regeneration
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What does the antinuclear antibody test detect?
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Ab that binds to nuclear components...whatever that means
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T/F You see a strongly regenerative anemia with IMHA.
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True. The BM is working just fine.
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Why do you see leukocytosis with a left shit on an IMHA patient's bloodwork????
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leukomoid reaction
...the BM is working so hard to pump RBCs out it starts shooting out immature WBCs too |
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What are some words to describe a regenerative anemia?
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retics
polychromasia nRBCs |
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T/F You see spherocytes in up to 95% of IMHA cases.
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True!
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How sensitive is the Direct Coomb's test for IMHA?
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it is positive in 70-90% of cases
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How do you treat IMHA? (it's in the name)
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corticosteroids aka immunosuppressants
IV Dexamethasone in hospital then Pred PO at home |
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What is the immunosuppressive dose of Prednisone?
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2 mg/kg
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If the immunosuppressive dose of Pred is 2 mg/kg, then what is the dose of Dexamethasone?
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2/7-10
(Dexamethasone is 7-10x as potent as Pred so we have to make sure we give a much smaller dose!!) |
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What's the rules of 3's with IMHA?
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1/3 get better
1/3 relapse when they're weaned off the meds 1/3 never respond to treatment |
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Why do we use CCS for IMHA?
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1. suppresses MPS activity
2. decreases complement & Ab binding to cells 3. suppresses Ab production |
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How long do we have to treat IMHA for with CCS?
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at least 4-6 mos....aka a really long time
(some may need life long therapy to remain in remission) |
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What are 3 additional drugs we can give to refractory cases of IMHA?
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cyclosporine (Atopica)
Azathioprine Leflunomide |
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What are last dtich efforts for IMHA patients that fail to respond to CCS, Atopica, Azathioprine, & leflunomide?
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cyclophosphamide (cytoxan) or splenectomy or mycophenolate mofetil....
....none of these are ever recommended as first-line treatment |
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What are some ABx a doctor might decide to put an IMHA dog on?
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azithromycin
doxy |
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What is a side effect of cyclophosphamide?
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sterile hemorrhagic cystitis
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Blood transfusions are necessary with a severe acute drop in PCV (as occurs with IMHA).
What is our goal PCV for our IMHA patient? |
20-30%
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What does Oxyglobin transfusion achieve?
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increased oxygen-carrying capacity; NOT increased RBC count
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IMHA patients are in a hypercoaguable state, putting them at risk for...
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DIC!!
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Because IMHA patients are in a hypercoaguable state, we want to dilute their blood so it doesn't clot up. How do we achieve this?
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IVF
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IMHA patients at high risk for thromboembolism & DIC should receive:
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low-dose aspirin (yes, even with the CCS we have them on)
or Clopidogre (Plavix) |
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What DOESN'T Dr. Green recommend giving patients that have a history of IMHA?
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vx
reckless use of ABx |
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What blood parameter is the FIRST indication that an animal is having an IMHA relapse?
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increased retic count
(retics will go up before the PCV drops) |
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What's the prognosis for IMHA?
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nobody really knows, tho it seems like up to 75% survive the initial crisis?
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Secondary hemostatic disorders are due to...
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coag factors
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Platelets create ___________ hemostatic disorders
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primary
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oozing of blood thru mucous membranes -->
melena hematochezia hematuria epistaxis Is this primary or secondary hemostatic disorder? |
primary causes oozing
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When you do venipuncture on a dog a huge hematoma develops on his leg. HUGE!
Is this primary or secondary hemostatic disorder? |
secondary of course
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You do venipuncture on a patient and his leg oozes small amount of blood for several minutes.
Primary or secondary hemostatic disorder? |
primary
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When do you see petechiae & ecchymoses?
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primary hemostatic disorder
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What is the most common cause of primary hemostatic defects?
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Thrombocytopenia
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What are four causes of thrombocytopathy aka platelet dysfunction?
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Uremia
Hereditary Monoclonal gammopathies Drugs/vx |
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What a the two commonest causes of secondary hemostatic defects?
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Rodenticide & liver disease
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What is the most common cause of combined primary & secondary hemostatic defects?
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DIC
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Name four tests to evaluate primary hemostasis.
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Blood smear
Platelet count BMBT PFA |
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Name three tests to evaluate secondary hemostasis.
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ACT
OSPT APTT |
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What are the two causes of primary ITP?
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SLE & idiopathic
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What a the three broad categories causing a secondary Thrombocytopenia?
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Infections
Neoplasia Drugs |
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Give me am pretty standard signalment for ITP.
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Middle aged female cocker or poodle
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What is the commonest cause of spontaneous bleeding in dogs?
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immune mediated thrombocytopenia (ITP)
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Does ITP usually present as a chronic or acute onset of signs?
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acute
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Platelet counts under ____ --> petechiae
Platelet counts under ______ --> spontaneous bleeding. |
50,000 petechiae
20-30,000 spontaneous bleeding |
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How many platelets do cats need before they start spontaneously bleeding?
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CATS = 5,000
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What is hyphema & is it causted by primary or secondary bleeding disorder?
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blood in the anterior chamber of the eye
primary |
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ITP can cause GI bleeding. T/F
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True...it can cause either melena or hematochezia
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Why are rectal exams important?
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check for melena
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What are the 4 treatment goals for an ITP dog?
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stop immune-mediated destruction of platelets
reduce blood loss maintain tissue oxygenation provide adequate perfusion |
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How do we "reduce blood loss?"
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cage rest to minimize trauma
GI protectants (sucralafate or famotadine) minimize venipuncture & avoid large veins (ie dont place a central line) minimize other percutaneous procedures (eg liver FNA or cystocentesis) |
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How do we "maintain tissue oxygenation?"
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keep PCV adequate with whole blood transfusion
monitor for development of IMHA |
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How do we provide "adequate perfusion?"
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IVF
Maintain BP |
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Depending on presentation, what are the 2 main drugs we're going to put an ITP dog on?
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immunosuppressives
doxy (in case its tick related) |
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What! T/F Vincristine can be used to increase platelet counts.
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true...but they don't know if those platelets function or not...it might just be to make us feel better when we see the counts
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What are 3 ways to "give" or "increase" platelets?
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vincristine
DMSO preserved platelets platelet cryoprecipitate/platelet-rich plasma |
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Is it easy or effective to give platelet transfusions?
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no & no....no no no
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T/F We give whole blood transfusions to ITP dogs to get platelets into them.
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False. We do it to correct anemia if they've been bleeding out.
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What's the prognosis for ITP?
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well, 70% respond to therapy but a quarter of those cases recur.
Evan's syndrome = poorer prognosis |
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What is the commonest inherited bleeding disorder in dogs?
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vWD
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What is type I vWD?
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decreased concentration of NORMAL vWF seen in DOBIES
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What is type 2 vWD?
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low to normal concentration of of ABNORMAL vWF
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What is type 3 vWD?
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absence of vWF
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Which clotting factor is vWF complexed to in circulation?
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factor VIII
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What is the role of vWF?
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it causes platelets to adhere to the subendothelial collagen after vessel damage....thus initiating the primary hemostatic plug
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Do dogs with vWD spontaneously bleed?
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not usually. But they will have signs associated with primary hemostatic defects following surgery, venipuncture, etc.
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How do you diagnose vWD?
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NORMAL PLATELET COUNT (remember??)
prolonged BMBT, PFA quantification of vWF |
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What's desmopressin acetate (DDAVP) all about?
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it causes massive release of vWF from endothelial cells...
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Which type(s) of vWD is DDAVP effective for?
(this drug causes massive release of vWF from endothelials) |
only type 1, because that has NORMAL vWF just low concentrations of it
(type 2 & 3 have abnormal or NO vWF so DDAVP wouldn't help anything) |
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Blood products can increase vWF concentrations...which products?
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fresh frozen plasma
whole fresh blood cryopreciptate |
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What are the 4 Vitamin K antagonist rodenticides?
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brodifacoum
bromadiolone diphacinone warfarin |
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What are the vitamin K dependent clotting factors?
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2 7 9 10 BRETT
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How could rodenticide poisoning --> dyspnea, coughing, thoracic pain?
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hemothorax (secondary clotting factors --> body cavity bleeds)
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What are the 2 signs of secondary hemostatic defects?
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hematoma
body cavity bleeds (intrathoracic, intrapulmonary) |
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What CBC changes will you see in a rodenticide poisoning?
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regenerative anemia
(maybe a mild TCP) |
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What coag changes will you see in a rodenticide poisoning?
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prolonged OSPT then APTT
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What is the order in which the following become prolonged?
clinical bleeding APTT OSPT |
OSPT --> APTT --> clinical bleeding
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What is PIVKA?
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proteins induced by vitamin K antagonism
PIVKA levels will INCREASE w/ rodenticide poisoning |
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What is phytonadione?
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vitamin K1 therapy
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Why dont we treat with vitamin K3?
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hurts the kidneys
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What is Vitamin K1 drug we use called?
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phytonadione
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In a rodenticide poisoning, we treat with Vit K1 for a long time. 1-2 days after discontinuing treatment, what blood test should we check?
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OSPT
(remember, this is the first thing that will change with Vitamin K antagonism) |
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What is the prognosis for rodenticide poisoning?
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excellent if caught & treated early
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Why is Genny going to get in trouble at Cornell for bringing food into the ICU when there's a pancreatitis dog in there?
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cause the sight or smell of food stimulates the pancreas .... an active pancreas doesn't heal!
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How many pancreatic ducts are there in dogs vs cats?
What are they called? |
Dogs:2
Major & accessory Cats:1 Major |
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What do the islets of langerhans cells secrete (4)?
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insulin
glucagon somatostatin pancreatic polypeptide |
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What are the exocrine cells of the pancreas called & what do they secrete?
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acinar cells
bicarb & enzyme-rich fluid |
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Describe the CCK pathway...
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CCK causes the release of digestive enyzmes in to the SI in response to food
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Describe the Secretin pathway
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Secretin results in bicarb secretion from the pancreas in response to HCl in the duodenum
(Why would there be HCl in the duodenum? From the stomach!) |
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What is Vitamin B12?
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cobalamin
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What do we have to know about B12 & the pancreas?
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the pancreas releases intrinsic factor, which is necessary for B12 absorption in the ileum
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What is one of cobalamin's roles in the GIT?
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prevents bacterial overgrowthin the SI
(also required for RBC synthesis!) |
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What are zymogens?
Why are pancreatic enzymes released as zymogens? |
enzymes that are sequestered (stored) in an inactive form
because pancreatic enzymes break down proteins, you don't want them sitting in the pancreas eating it away |
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When are zymogens activated?
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when they reach the duodenum & come in contact with HCl
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Tell me the 2 facts we need to know about enterokinase.
Trypsin? |
made by enterocytes (it's in the name)
cleaves inactivat trypsinogen to active trypsin Trypsin activates the other digestive zymogens in a cascade fashion |
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Why do you think acinar cells have the protective function of producing "pancreatic secretory trypsin inhibitor PTSI?"
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to inactivate any trypsin that accidentally gets activated inside the pancreas
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What's to know about alpha 1-protease inhibitor?
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it's sent out for PLE....no clue
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normal PTH
high ionized Ca2+ what's the dz? |
primary hyperparathyroidism
(just for the fun of it) |
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What's the pathogenesis of pancreatitis?
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intrapancreatic enzyme activation --> lots of enzymes released into circulation.
Local pancreatic inflammation --> extension locally & systemically |
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What are the 4 possible end-results of pancreatitis?
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**hypotension
**shock **DIC **Death this is important for NAVLE |
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What are the 9 risk factors/dz predisposing to pancreatitis?
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fatty
drugs ischemia abdominal trauma or sx hyperlipoproteinemia duodenal reflux DM, Cushings, Hypothyroidism |
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What 3 drugs like to cause pancreatitis?
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L-asparaginase
Anticonvulsants (phenobarb & KBr) |
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Who does pancreatitis commonly occur in?
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small fat dogs that ate a steak
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T/F If you see pancreatitis in a large breed dog, you must find out why!
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true....
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What are the common CS of pancreatitis?
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vomiting
abdominal pain* weakness diarrhea anorexia/depression fever jaundice |
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What are SEVERE CS of pancreatitis?
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hemorrhagic diarrhea
petechia & ecchymoses respiratory distress tachycardia/tachypnea shock DIC death |
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Why might pancreatitis cause tachycardia & tachypnea?
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hypovolemia (vomiting/diarrhea)
pain |
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What does pancreatitis cause on CBC?
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inflammatory leukogram
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Do we biopsy the pancreas for diagnosis?
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no that would make it even worse...we just use bloodwork & imaging (& CS) to make our diagnosis.
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Speaking of imaging...
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U/S: black pancreas surounded by bright tissue....
corrugated duodenum |
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What is more sensitive/specific for pancreatitis--PLI or TLI?
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PLI
remember, low TLI = EPI |
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T/F Amylase & lipase are not consistently reliable for diagnosis of pancreatitis.
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true, they kinda suck
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What are the 4 chemistry changes?
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azotemia
liver enz up hyperbilirubinemia acidosis (tho vomiting can cause alkalosis) |
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What do we have to know about clotting & pancreatitis?
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they can get DIC & coagulopathies...which gives them a poor prognosis
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What kind of azotemia does pancreatitis cause?
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pre-renal (dehydration) or renal
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I think this is rare cause I crossed it out in my notes....hyperglycemia & hypokalemia??
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who knows.
guess they could be hyperglycemic from the stress of being sick |
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PLI is very ...
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sensitive, NOT specific...tho it's 78% specificity according to ACVIM ?
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PLI measures
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only lipase that originates from the exocrine pancreas
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What are non-pancreatic causes of increased lipase / amylase?
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azotemia (because of decreased renal excretion)
dexamethasone (increases lipase) other organs... |
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T/F PLI declines during recovery, so it can be used to monitor the patient.
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true
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SNAP cPL correlates well with...
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Spec cPL
wtf is "spec?" |
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Why does the duodenum look corrugated on U/S when they have pancreatitis?
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cause of the inflammation
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Why do we give dogs with pancreatitis antibiotics?
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NOT because pancreatitis is infectious in nature, but because the inflammation of the duodenum & colon --> translocation of bacteria!!
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What are your treatments for pancreatitis?
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NPO
IVF Antibiotics Anti-emetics (metoclopramide CRI) Analgesics (NOT butorphanol or NSAIDs) Low-fat diets (long-term) |
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Why don't we use butorphanol for pain management in pancreatitis?
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cause it's a "pathetic analgesic"
better choice = morphine or fentanyl CRI |
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When would we do surgery on a pancreatitis dog??
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if the dog is yellow & there is distention of the common bile duct due to pancreatitis?
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When should you start feeding a pancreatitis dog?
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if there has been no vomiting for 2 days or so...feed him a low-fat diet
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T/F The gut needs nutrition to get better.
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true (this is not just true for pancreatitis, eg it's true for parvo)
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Tell me 4 things about feline pancreatitis.
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subclinical
triaditis NO vomiting amylase/lipase NOT useful |
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What is triaditis?
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faaaaack i dont remember...
pancreatitis cholangiohepatitis IBD |
