Approach to anaemia 2

Question 1

What is the overall role of treatment for IMHA?

Answer 1

Immunosuppressive therapy

Question 2

Which drugs is used for first line immunosuppressive therapy?

Answer 2

Prednisolone - Oral

Question 3

If an animal is inappetent and wont take prednisolone orally which drug can be used instead?

Answer 3

Dexamethasone - IV

Question 4

Give examples of other immunosuppressive drugs

Answer 4

• Azathioprine
• Ciclosporin
• Leflunomide

Question 5

Which immunosuppressive drugs is toxic to cats?

Answer 5

Azathioprine

Question 6

Give some side effects related to prednisolone

Answer 6

• Polyuria, polydipsia, polyphagia
• GI toxicity
• Muscle wastage

Question 7

How can you decide if it is necessary to use a second immunosuppressive treatment?

Answer 7

• Clinical features of severe /life threatening disease
• No response to corticosteroids over first 7d
• Patient with or at risk of severe corticosteroid side effects

Question 8

Describe dosing and length of treatment for IMHA

Answer 8

• Start ‘high’ and gradually reduce doses if anaemia under control
• Minimum 2-3 weeks between dose reductions
• Prednisolone treatments lasts 3-6 months
• Some animals may relapse and be on treatment for life

Question 9

How do immunoglobulins work as an immunosuppressive treatment?

Answer 9

Block Fc receptor of macrophages and bind/block circulating antibodies

Question 10

Immune mediated haemolytic anaemia leads to a high risk of what disease?

Answer 10

Thromboembolic disease

Question 11

Which drugs would be used for:

• primary haemostasis?
• secondary haemostasis?

Answer 11

• Antiplatelet drug e.g. Clopidogrel

- Anticoagulant e.g. unfractionate heparin

Question 12

Describe neonatal isoerythrolysis in a dogs

Answer 12

• Very rare but can occur in puppies
• Destruction of neonates RBCs by maternal antibodies
• DEA1.1 positive puppies affected

Question 13

Describe neonatal isoerythrolysis in a cat

Answer 13

• Rare
• Type A or AB kitten born to a type B queen
• British shorthairs

Question 14

What is microangiopathic haemolytic anaemia?

Answer 14

• RBCs are mechanically damaged or fragmented as they pass through fibrin mesh works in the microvasculature

Question 15

What could be the possible underlying causes of microangiopathic haemeolytic anaemia

Answer 15

• Altered vasculature e.g. haemangiosarcoma
• Fibrin nets - DIC
• Glomerulonephritis

Question 16

What is the name given to fragmented RBCs?

Answer 16

Schistocytes

Question 17

A RBC with multiple, rounded projections of variable length is a ?

Answer 17

Acanthocyte

Question 18

What are the causes of acanthocytes?

Answer 18

• Liver disease
• Lymphoma
• Glomerulonephritis
• Cholesterol metabolism abnormalities

Question 19

What can cause oxidative injury to RBCs in:

• dogs
• cats

Answer 19

• Onions, zinc

- Paracetamol

Question 20

Oxidative injury results in … ?

Answer 20

• Heinz body formation

- RBC membrane oxidation (eccentrocytes)

Question 21

What are Heinz bodies?

Answer 21

Clumps of damaged haemoglobin attached to your red blood cells

Question 22

Which stain highlights Heinz bodies?

Answer 22

New Methylene blue

Question 23

Give some examples of blood parasites

Answer 23

• Mycoplasma haemofelis
• Babesia canis
• Ehrlichia

Question 24

What type of anaemia is caused by Mycoplasma haemofelis?

Answer 24

• Regenerative anaemia

- Immune mediated haemolysis

Question 25

Mycoplasma haemofelis usually only causes anaemia in dogs which have undergone which surgical treatment?

Answer 25

Splenectomy

Question 26

How can mycoplasma haemofelis be diagnosed?

Answer 26

PCR | - once infected, always infected

Question 27

Non-regenerative anaemia has the absence of which cells?

Answer 27

Reticulocytes

Question 28

What are the causes of non-regenerative anaemia?

Answer 28

- Primary marrow disease | - Lack of erythropoietin (e.g. due to kidney disease)

Question 29

What are some causes of intramarrow disease?

Answer 29

- idiosyncratic drug reactions - Oestrogen toxicity - Pure red cell aplasia - Myelofibrosis

Question 30

What is an idiosyncratic drug reaction?

Answer 30

Unpredictable, individual adverse reaction to a drug

Question 31

What is myelofibrosis?

Answer 31

Proliferation of collagen and reticulin fibres in bone marrow

Question 32

Describe the features of anaemia of chronic disease

Answer 32

- very common - normocytic, normochromic - non-regenerative

Question 33

Does anaemia of chronic disease require treatment?

Answer 33

Doesn't require specific therapy - it should resolve once the underlying disease is cured

Question 34

Why does chronic kidney disease cause anaemia?

Answer 34

Reduced erythropoietin production => reduced erythropoiesis

Question 35

Which 2 feline retroviruses can cause non-regenerative anaemia?

Answer 35

Feline immunodeficiency virus (FIV) | Feline Leukaemia virus (FeLV)