Final exam - transfusions / immune-mediated disease Flashcards

(54 cards)

1
Q

How quickly do you expect to see regeneration of RBCs?

A

3-5 days

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2
Q

What are the (very) general ddx for anemia?

A

Non-regenerative: various chronic dz processes

Regenerative: loss or lysis (immune-mediated, toxic)

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3
Q

What are the canine blood groups? What is considered the “universal donor”?

A

DEA 1.1, 1.2, 3, 4, 5, 6, 7, 8; DAL-Dal

Universal is DEA 4+, negative for all others (anti-DEA 4 do not cause hemolysis)

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4
Q

What are the feline blood groups? What is the “universal donor”?

A

Type A, B, AB; MIK

NO universal donor

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5
Q

Fill in the blank: NEVER transfuse __ blood to __ cats

A

NEVER transfuse A blood to B cats

Type B cats have HIGH levels of anti-A Ab’s (Brits hate Americans)

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6
Q

What are the 4 broad indications for transfusion?

A
  1. Anemia
  2. Coagulopathies
  3. Hypoalbuminemia - volumes to raise plasma albumin levels are tremendous, don’t use for this reason alone
  4. Thrombocytopenia - may last only minutes to hours, use only in crisis
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7
Q

How are canine blood donors selected?

A

> 25 kg lean body weight
Normal/healthy - routine CBC/chem/UA/fecal
Neg for HW, Lyme, Borrelia, Rickettsial dz
DEA 1.1, 1.2, and 7 negative
Greyhounds - usually universal donors, lean with good veins, PCV often higher

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8
Q

How are feline blood donors selected?

A

> 4.5kg lean body weight
Indoor only and neg for FeLV/FIV, T. gondii, Bardonella
Normal/healthy - routine CBC/chem/UA/fecal
Males preferred

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9
Q

How much blood (based on BW) can be donated?

A

1% of BW (10% of blood volume, BW is 10% blood)

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10
Q

What is in plasma?

A

Everything but RBC (WBC, hemostatic factors, albumin, globulins, etc.)

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11
Q

What is in cryoprecipitate?

A

vWF and factor VII

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12
Q

What is in cryosupernatant?

A

Factors II, VII, IX, XII; albumin, globulins

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13
Q

What supplementation is recommended for blood donors?

A

IV crystalloids while donating

Ferrous sulfate supplements

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14
Q

What does the major crossmatch test?

A

Recipient sera + donor RBC

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15
Q

What does the minor crossmatch test?

A

Donor sera + recipient RBC

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16
Q

When should transfusion be considered? Clinical signs and clin path findings

A
  1. Tachycardia, tachypnea, dyspnea
  2. Depressed from anemia
  3. PCV <12-15% (chronic) or acutely drops
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17
Q

How can you calculate how much blood to transfuse? (Real equation and quick estimation)

A

mL needed = recipient blood vol x [(desired PCV - current PCV) / PCV of donor]
*1mL (FWB) per pound raises the PCV by 1%
10-20 mL/kg FWB is the general indication

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18
Q

What immunologic complications are associated with blood transfusion?

A

Fever
Hemolysis
Acute hypersensitivity
Immunosuppression

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19
Q

What non-immunologic complications are associated with blood transfusion?

A
Circulatory overload
Bacterial contamination
Transmission of infectious diseases
Citrate toxicity (hypoCa)
Pulmonary microembolism / TRALI
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20
Q

What CS are associated with a transfusion complication?

A

Body temp increases >1ºC
Tachycardia, tachypnea, vomiting develops
Hemoglobinuria
Anaphylaxis: hypotension, urticaria, respiratory distress

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21
Q

How are transfusion complications treated?

A

STOP the transfusion (duh.)
Give crystalloids (or colloids if low BP)
Diphenhydramine for anaphylaxis
Dexamthasone sodium phosphate / epinephrine for shock
Pred acetate for urticaria only

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22
Q

What is oxyglobin? How does it work?

A

Polymerized bovine hemoglobin - no crossmatch needed, long shelf life
Increases free HgB

23
Q

When are hetastarch/vetstarch indicated?

A

Hypotension, hypoproteinemia, hypoalbuminemia (*<1.5 albumin = fluid loss)
Used to maintain fluid within vascular space

24
Q

When is human albumin indicated?

A

OFF LABEL use for hypoalbuminemia and resuscitation

25
What are the etiologies for IMHA?
Primary - immune-mediated Secondary -Medications (sulfas, etc.), toxins, venom -Immunologic (SLE, etc.) -Infectious (FeLV, Babesia, Lepto, etc.) -Neoplastic (lymphoma, hemangiosarc, etc.)
26
What is the clinical history of a patient with IMHA?
Lethargy, weakness, pale mms, +/- hemolysis (pigmenturia and icterus)
27
How is IMHA diagnosed?
Anemia (usually regenerative) 1. autoagglutination 2. spherocytosis (dogs only) 3. + Coombs test (60-80% positive)
28
What additional workup should be done once IMHA is diagnosed?
1. Imaging to look for secondary causes 2. Coag panel to r/o blood loss and recognize DIC 3. Arterial blood gas/SAO2 to detect pulmonary thromboembolism
29
What is the cause of death in most cases of IMHA?
Hypercoagulability and thromboembolism
30
What is Virchow's triangle?
Describes parameters that predispose thromboembolism 1. Endothelial damage 2. Blood stasis/altered flow 3. Hypercoagulability
31
What is the general treatment strategy for IMHA?
Treat secondary cause Immunosuppression: -Glucocorticoids (2-4 mg/kg/day) -Azathioprine
32
What adjunct therapies are used in IMHA cases?
1. Blood products to minimize tissue hypoxia 2. Gastric protectants 3. Aspirin/clopidigrel (anti-thrombotics to prevent TE)
33
What is the prognosis for IMHA? What are some NPIs?
50% in hospital mortality | NPIs: bilirubin >10mg/dL, autoagglutination
34
What are the main differences in feline IMHA?
``` Affects male cats <50% regenerative anemia Lymphocytosis common Rarely TE Lower mortality ```
35
What are the general ddx for thrombocytopenia?
1. Destruction (immune-mediated, infectious, drugs) 2. Consumption (DIC, neoplasia, loss d/t bleeding, sequestration) 3. Decreased production (bone marrow dz, drugs)
36
What are the etiologies of ITP?
``` Primary -autoimmune -idopathic -genetic? Secondary -infection (Anaplasma, E. canis) -neoplasia -drugs (sulfas, cephs) ```
37
What clinical signs are consistent with ITP?
Petechia, ecchymosis | Lethargy/anorexia, bruising, anemia
38
How is ITP diagnosed?
Presumptive dx by r/o other causes - CBC, tick panels, UA - coag profile - imaging - bone marrow
39
How is ITP treated?
1. eliminate underlying risks 2. minimize bleeding 3. immunosuppression - glucocorticoids (2-4mg/kg/day) - azathioprine 4. Minimize adverse effects - GI protectants, pRBCs, O2, etc.
40
What is the prognosis of ITP?
Most improve within 7-10 days | Mortality ~30%
41
What clinical signs are consistent with SLE?
Polyarthropathy, skin lesions, proteinuria, blood dyscrasias (anemia, thrombocytopenia)
42
How is SLE diagnosed?
ANA (not very reliable) | Definitive dx: +ANA and 2 body systems with immune dz
43
How is SLE treated?
Immunosuppression -Prednisone -Azathioprine / cyclosporin Levamisole (anti-parasite, immunomodulator)
44
What is the prognosis for SLE cases?
Guarded. Relapses common, often require long-term therapy
45
What are the general ddx for polyarthropathies?
``` Infectious (tick) Osteoarthritis Immune-mediated: -SLE -Erosive (rheumatoid) -Non-erosive (infectious, hepatic/GI-associated, neoplasia) ```
46
What clinical signs are associated with IMPAs
Lameness, fever, joint pain
47
What is the general workup for IMPAs?
``` CBC (non-specific) Chem (liver up) U/A (proteinuria) Joint rads Tick panel Arthrocentesis ```
48
How do arthrocentesis results differ between primary/secondary IMPA and rheumatoid arthritis?
Primary/secondary IMPA > non-degenerate neutrophils | Rheumatoid > degenerate neutrophils
49
How is IMPA treated?
Prednisone (immunosuppressive) | Azathioprine (careful of hepatotox) / mycophenolate
50
What is the prognosis for primary IMPA?
Good!
51
What signalment is associated with erosive (rheumatoid) arthritis?
Small/medium breeds | Greyhounds, Shelties
52
What is the pathogenesis of rheumatoid arthritis?
RFs and anti-IgG antibodies contribute to immune-complex formation in joints > synovitis and erosive joint changes
53
How is rheumatoid arthritis diagnosed?
MDB like IMPA Rads (early may not show erosions) Joint tap (degenerate neutrophils) RF factor positive
54
How is rheumatoid arthritis treated? What is the prognosis?
No specific tx - pain management, immunosuppression may slow progression POOR prognosis