Haematopoetic Treatment

Question 1

Haemorrhage - trauma (ruminant)

Answer 1

• Prevention of ongoing losses: pressure/packing; surgical repair
• Correction of deficits: volume replacement; blood transfusion

Question 2

Haemorrhage - abomasal ulceration (ruminant)

Answer 2

• Acute = high-grade ulcer, poor Px, consider euthanasia
• Chronic - dietary modification - dec CHO, inc NDf

Question 3

Haemorrhage - pulmonary thromboembolism (ruminant)

Answer 3

(Poor individual Px)
- Systemic AB
- +/- Blood transfusion
- Dietary modification

Question 4

Babesiosis -> anaemia (cow)

Answer 4

• Imidocarb propionate (Imizol) - only licensed Tx for Babesia divergens (also used as preventative)
• Blood transfusion
• NSAIDs for fever

Question 5

Brassica poisoning (cow)

Answer 5

• Blood transfusion

Question 6

Tick-borne fever (anaplasmosis) (ruminant - sheep)

Answer 6

• AB: Sulfonamides / tetracyclines
• Establish/maintain immunity
• Avoid moving non-immune animals to at-risk grazing during breeding season

Question 7

Iron-deficiency anaemia (porcine)

Answer 7

• Fe IM
• Creep feed supplementation
• Prevention = 200 mg Fe injections IM neck to piglets under 3d

Question 8

Haemorrhage (porcine)

Answer 8

• Sx
• Supportive

Question 9

Warfarin coagulopathy (porcine)

Answer 9

• Vit K preparations

Question 10

Porcine dermatitis and nephropathy syndrome (PDNS) (PCV2) (porcine)

Answer 10

• PCV2 vaccination
• Biosecurity

Question 11

Infectious bursal disease (IBD, Gumboro) (poultry)

Answer 11

• No curative
• Supportive

Question 12

Canine lymphoma

Answer 12

• Multicentric
• (QoL improvement, eventually relapse w/ chemo-resistant, disseminated disease)
• Sx (solitary site) - nodal, extranodal - splenectomy, GI perforation
• Radiation therapy - half body irradiation, solitary extranodal, palliative
• Immunotherapy - MAb 231
• Chemotherapy - mainstay of therapy (CHOP - cyclophosphamide (cytoxan), doxorubicin (adriamycin), vincristine (oncovin), prednisolone, L-asparaginase - multiple protocols = greater survival, costs, toxicity, visits

Question 13

Feline lymphoma

Answer 13

• Sx - GI perforation
• Radiation - mediastinal, nasal
• Chemotherapy - mainstay, multidrug, doxorubicin for induction

Question 14

Leukaemia (companion animal)

Answer 14

• Supportive care - BM sig suppressed
• Aggressive chemo (poorly responsive) - average survival <4 m

Question 15

Polycythaemia vera (neoplasia) (companion animal)

Answer 15

• Phlebotomy (blood withdrawals), dec circulating PCV
• Radiophosphorus
• Every 2 - 3 m
• Hydroxyurea -> reversible myelosuppression

Question 16

Chronic lymphocytic leukaemia (CLL) (companion animal)

Answer 16

• Chlorambucil long-term
• Prednisolone

Question 17

Normochromic, normocytic - regenerative anaemia

Answer 17

• Packed red blood cells
• (Has no coagulation factors so not for coagulopathies)

Question 18

Bleeding disorders (companion animal)

Answer 18

• Coagulopathies (e.g. vit K deficiency + rodenticide poisoning) - SC/PO vit K
• Anti-coagulation/anti-clotting - heparin; low molecular weight heparins (LMWHs)
• Antiplatelets - aspirin; clopidogrel

Question 19

Coagulopathy + active haemorrhage

Answer 19

• Fresh whole blood - replacing RBCs + clotting factors

Question 20

Coagulopathy (w/o anaemia)

Answer 20

• Fresh frozen plasma (FFP)

Question 21

Vitamin K deficiency e.g. rodenticide toxicity

Answer 21

• Frozen plasma (don’t need all clotting factors)
• Cryoprecipitate
• Cryo-supernatant

Question 22

von Willebrands Disease

Answer 22

• Cryo-precipitate, smaller vol of clotting factors, less risk of vol overload
• (FFP)

Question 23

Transfusion volume (anaemia)

Answer 23

Question 24

Transfusion volume (coagulopathy)

Answer 24

Question 25

Rate of transfusion administration

Answer 25

Question 26

Acute immunological transfusion reaction (mild)

Answer 26

- Reduce rate (half rate of admin) - Stop transfusion - allow temp, pulse + resp to normalise + restarts at lower rate (half initial rate)

Question 27

Acute immunological transfusion reaction (severe)

Answer 27

(Not definitive Tx, manages CS) - Stop transfusion - decide whether to wait for signs to subside + restart at 50% of previous rate or abandon transfusion + balance severity of reaction - IV fluids - maintains BP Drugs, if anaphylactic (hypersensitivity) reaction: - Corticosteroids - only if normotensive - Anti-histamines - chlorphenamine IV - Dexamethasone - Rare - IV adrenaline/ephedrine

Question 28

Primary IMHA (dog)

Answer 28

- Initial (48 h) - dexamethasone, IV SID - Once eating: prednisolone, then reduce dose after 1 - 2 w; azathioprine PO q24 h (immunosuppresion); clopidogrel (anti-platelet) - 3 - 8 m of Tx

Question 29

Non-regenerative precursor IMHA, IMHA within BM (companion animal)

Answer 29

- Prednisolone PO SID - Ciclosporine PO BID - Clopidogrel PO q24 h - Follow-up q2 - 3 w full haem + blood smear to external lab for reticulocyte count, lower dose if inc PCV, continue ciclosporine, cessation of prednisolone

Question 30

Microcytic non-regenerative anaemia, suspected iron deficiency anaemia (companion animal)

Answer 30

- IM Iron dextrans (3 - 4 w)

Question 31

Hypocobalaminaemia (Vit B12) and hypofolatemia

Answer 31

- SC vit B - Oral Coabalalex (vit B12 + folate supplement)

Question 32

Lungworm coagulopathy

Answer 32

- Fresh frozen plasma (FFP)

Question 33

Haemophilia A (VIII)

Answer 33

- FFP - Cryoprecipitate

Question 34

Haemophilia B (IX)

Answer 34

- FFP - Cryosupernatant

Question 35

Hyperfibrinolysis (e.g. greyhounds)

Answer 35

- Tranexamic acid - prevents plasminogen activation, dec fibrinolysis + inc clot strength - Oral, IV, topical admin

Question 36

Immune-mediated thrombocytopoenia (ITP)

Answer 36

- Immunosuppression: corticosteroids (first line = prednisolone), vincristine (controversial, cytotoxic, immature platelets, func questionable - may not work as well, only use if not responding to steroids - +/- pRBCs transfusion for anaemia + CVS compromise Other: - Second line immunosuppression: azathioprine, cyclosporine, mycophenolate mofetil, human IV immunoglobulin - Splenectomy - Platelet transfusions

Question 37

Thrombocytopoenia

Answer 37

- Platelet transfusion - platelet-rich plasma - Not available in UK

Question 38

Anaemia (redmite = Dermanyssus gallinae) (poultry)

Answer 38

- Kill on surfaces - acaracide e.g. Hysolve CDM8 containing Abamectin + Permethrin; Elector (containing Spinosad) - Maintain biosecurity - Kill on bird - Exzolt in drinking water; Fluralaner = acaricide + insecticide - Coat - Pop - Upgrade housing - wood -> metal + plastic/heavily varnished wood - Hygiene - Nurse affected birds + Ivermectin 1% q10 d + Fipronil

Question 39

Chronic lymphocytic leukaemia (CLL) (companion animal)

Answer 39

- Chlorambucil longterm - Prednisolone - Survival approx over 18 m

Question 40

Chronic myeloid leukaemia (CML) (non-lymphoid leukaemia)

Answer 40

- Hydroxycarbamide - Hydroxyurea

Question 41

Multiple myeloma (cats + dogs)

Answer 41

- Melphalan - Prednisolone - Survival > 1.5 y