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ACVIM Certifier > Haemolymphatic > Flashcards

Haemolymphatic Flashcards

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1
Q

which genetic abnormality associated with methemoglobinemia in cats?

A

CYB5R3

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2
Q

which autoimmune condition could result in tumoral swellings of parotid and hyperglobulinemia?

A

IGG4 like disease

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3
Q

Which genetic defect may result in congenital methemoglobinemia in pomeranians?

A

CYP5RB3

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4
Q

what relapse rate is reported in dogs with SRMA tx with pred and azathioprine?

A

19%

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5
Q

What vitamin D metabolites are reduced in dogs with IM disease?

A

Calcidiol and calcitriol but not 24,25(OH)2D3 levels.

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6
Q

which sedation drug combination may be preferable for profound sedation in cats while avoiding changes in splenic imaging? Which combination leads to splenomegaly which may be mild on ultrasound and is unlikely to be clinically relevant?

A

a) dexmedetomidine and butorphanol b) alfaxalone and butorphanol

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7
Q

What percentage of isolates from dogs with positive BC are MDR? What factor increases likelihood of a positive BC result?

A

38.5% resistant to >/= 3 antimicrobial classes. Dogs with a positive urine culture were more likely to have a positive BC result.

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8
Q

Bone marrow samples from which site in dogs may be associated with higher myeloid to erythroid ratios?

A

Ileal crest (when compared to humeri)

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9
Q

why is Vitk1 therapy advised over vitk3?

A

Vit K3 slower onset of action and possible Heinz body formation

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10
Q

In cats receiving fresh frozen plasma transfusions, what is the median dose
of survivors and median dose of cats with improved coagulation times (and therefore may represent the advised initial dose pending prospective studies)?

A

6ml/kg

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11
Q

What genetic mutation associated with delayed post op bleeding in Scottish Deerhounds

A

SERPINF2

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12
Q

what is the mechanism of action of aminocaproic and tranexamic acid?

A

anti-fibrinolytic drugs; synthetic lysine analogs that reversibly binds to the lysine binding sites of plasminogen, prevents action of plasminogen on fibrin, thereby delaying fibrin dissolution and reducing bleeding. Interruption of fibrinolysis may be beneficial in patients with hyperfibrinolysis conditions and some forms of coagulopathy

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13
Q

congenital vitamin-K dependent coagulation factor deficiency has been reported in what cat breed?

A

Devon Rex

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14
Q

Haemophilia A and B reflect deficiencies in which coagulation factors respectively?

A

A- F 8
B- F 9
A more common than B and both forms have been documented in dogs and cats
Maine coons get F I and IX deficiency
prolonged APTT with normal PT
X linked recessive traits, therefore males most commonly affected

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15
Q

stored plasma is diminished in levels of which factors?

A

5 and 8

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16
Q

what is your differential diagnosis for a cat with prolonged APTT, normal PT and no bleeding tendencies?

A

Factor 12 (Hageman) factor deficiency; in-vivo clot formation primarily dependent on factor 7 and tissue factor activation. Concurrent haemophilia A or B (F 8 / 9) deficiency has been reported and can give rise to clinical signs of haemorrhage

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17
Q

what clotting test may be a surrogate marker for rivaroxaban activity in dogs if factor Xa activity not available?

A

PT

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18
Q

What is the MOA of enoxaparin?

A

binds to antithrombin which inihbits factor X (LMWH)

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19
Q

platelet dysfunction is increased in dogs receiving clopidogrel by the addition of which drug?

A

prednisolone

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20
Q

what is the MOA of clopidogrel

A

prevents ADP binding to p2y12 recentor

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21
Q

is there a difference in plt closure time, bmbt and vWF between dogs with necroinflammatory/fibrotic liver disease and healthy controls?

A

no difference

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22
Q

Which acute phase protein takes longest to normalise after inflammatory conditions in dogs?

A

haptoglobin

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23
Q

Which marker of oxidative stress has elevated plasma levels in dogs with IMHA

A

reduced glutathione

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24
Q

what mycotoxin has been associated with feline pancytopenia?

A

trichothece mycotoxin diacetoxylscerpinol

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25
What consequences of exposure to trichothecanes may be seen in cats?
bi or pancytopenia with marrow hypoplasia or aplasia
26
What is the mechanism of action of eltrombopag?
TPO receptor agonist (case report of dog with idiopathic aplastic pancytopenia - Eltrombopag was started after no response was seen to treatment with prednisolone and cyclosporine. Complete remission was achieved after the addition of eltrombopag and was sustained after stopping the medication.)
27
mortality is higher in dogs with extreme neutrophilic leukocytosis with which underlying disease process?
neoplasia
28
can urea:creatinine ratio discriminate occult GI bleed from healthy dog?
no difference
29
What may be a useful test to differentiate haemolytic anaemia from nonhemolytic anaemia other than CBC and blood smear?
carboxyhemoglobin - sensitivity/spec 90-100 based on values 4.55%-5.05%.
30
what are the most common AUS findings in dogs with IMHA
hepatomegaly, GB wall thickening and peritoneal effusion (JSAP)
31
What are the storage and transportable forms of iron? What enzymes are required for conversion of iron from storage to transport form?
STORAGE FORM - ferrous iron (Fe2+) - form found in haem groups Apoferritin is the iron storage protein (B-1 globulin produced by liver, negative APP, can bind up to 4500 Fe3+) - iron + apoferritin = ferritin - which is a POSITIVE APP Heemodesirin is iron + phosphate/ hydroxide- storage compound under conditions of excess iron (less rapid mobilisation than ferritin) TRANSPORTABLE FORM - Ferric iron (Fe3+) - form bound to apotransferrin (iron transport protein) in blood; iron + apotransferrin = transferrin, which is a negative acute phase protein ENZYMES REQUIRED FOR CONVERSION OF Fe2+ to Fe3+ FOR TRANSPORT: 1. Hephaestus - Copper dependent enzyme located on basolateral enterocyte, converts Fe2+ --> Fe3+ for transport 2. Ceruloplasmin - Copper dependent enzyme located on cellular membranes (e.g. macrophages), converts Fe2+ --> Fe3+ for transport
32
what protein, produced by the liver in response to increased iron stores and inflammation, inhibits iron release from cells and may be the main mediator of anaemia of chronic dz? Which protein hormone produced by erythroblasts inhibits production of the first protein from the liver?
Hepcidin (positive acute phase protein) - causes ferroportin-1 internalisation (this is the transporter needed to move iron (stored as ferritin) from inside enteropcyte to plasma where binds to apotransferrin and delivered to cells Erythroferrone production by erythroblasts inhibits production of hepcidin by the liver , erythropoietic activity overrides effect of iron stores on hepcidin (therefore hepcidin can be down regulated even in states of iron excess)
33
What 3 ways can iron be assessed on an iron panel?
1. Serum iron (poor marker of body iron stores due to rapid changes; measures iron bound to apotransferrin by 'liberating' it under low pH) 2. Total iron binding capacity = indirect measure of transferrin; normally approx 1/3 has iron bound at one time 3. % saturation of transferrin (serum iron/ TIBC) - <20% can be suggestive of Fe deficiency
34
how would iron panel results be expected to change in each of the following: 1. Low iron due to transient variation and inflammatory disease 2. Inflammation >24-48hrs 3. Protein losing enteropathy leading to loss or decreased production of transferrin 4. Haemolytic anaemia/ PIMA or PRCA
1. Serum iron reduced, TIBC normal, % saturation of transferrin reduced 2. Decreased iron (due to inflammatory cytokines, hepcidin) AND TIBC (due to transferrin being a negative APP) - therefore normal % saturation 3. Iron normal, TIBC reduced and % saturation either normal or increased 4. Increased serum iron with normal TIBC and increased % saturation
35
what is the difference between functional and absolute iron deficiency?
Absolute iron deficiency results from a severe reduction or absence of iron stores. Functional iron deficiency occurs in the presence of adequate iron stores but insufficient iron availability (thus, it is not a true deficiency of body stores)
36
which form of feline reticulocytes are considered most important for assessing response to anaemia are are counted by automated haematology analysers ?
aggregate reticulocytes. (other form = punctate)
37
what impact does a 49:1 saline to blood dilution have compared to 1:1 on utility of SAT for diagnosing IMHA in dogs?
Specificity increased from 29% to 97% and sensitivity reduced from 88% at 1:1 to 67% at 49;1 (and also 67% send at 4:1 and 9:1 dilutions). Diagnostic accuracy increased from 33% at 1:1 to 95% at 49:1 dilution
38
Which cytokine may inform likelihood of survival in dogs with IMHA when measured throughout hospitalisation?
IL17 (Serum IL-17 concentration remained significantly higher in nonsurviving IMHA dogs whereas it significantly decreased during hospitalization in survivors, making serum IL-17 concentration a potential biomarker for severity and response to treatment in IMHA.)
39
What findings were positively associated with bartonella infection in cats?
neutrophilia, decreased ALP, sick status and young age
40
What proportion of thrombocytopenic dogs without primary ITP have autoplatelet antibodies?
20% (and 100% ITP dogs) - persistence not useful to monitor treatment response but recurrence can be useful to detect relapse in ITP
41
what sort of platelets are present in response to vincristine administration and what stain can be used to detect them?
reticulated platelets (ie immature platelets)- thiazole orange staining
42
What factor is associated with improved outcome in non-regenerative immune-mediated anaemia? Erythroid regeneration and remission were achieved by what percentage of dogs with nrIMHA? What breeds appear predisposed?
Corrected reticulocyte percentage >0.2 associated with improved survival Erythroid regeneration and remission were achieved by 88% and 62% of dogs, respectively. whippets, Lurchers, and miniature Dachshunds were predisposed to nrIMA.
43
What is the median time to regenerative response in cases of PIMA?
29 days (JAVMA paper- 83% dogs developed regenerative response, so similar to JVIM paper where was 88%, median time 29 d (range 2-111 d) , 73% entered remission (so better than 62% in JVIM paper)
44
What test may help differentiate pre-regenerative anaemia from non-regenerative anaemia in dogs?
immature reticulocyte fraction
45
What is the MOA of inhaled albuterol for management of hyperkalaemia?
B2 agonist, promites intracellular storage of K by insulin release and upregulating NaKATPase channels.
46
Which markers of coagulabiltiy are increased in dogs with SARDS compared to healthy cotnrols?
all dogs with SARDS were hypercoagulable based on increased G values and fibronogen
47
which breed have been reported as at risk of familial primary lymphedema?
Bulldogs, poodles, old English sheepdogs, Labrador retrievers
48
what is the proposed mechanism for ruin helping with lymphedema?
rutin = benzopyrones - group of drugs that have been advocated to reduce high-protein lymphedema by stimulating macrophages, promoting proteolysis and enhancing absorption of protein fragments, proof of efficacy in tx of lymphedema is lacking
49
list differentials for each of the following on splenic US: -1. Hyperechoic nodular lesions 2. Multiple hypo echoic nodules with swiss-cheese/ honey comb appearance 3. Focal hypocehoic territorial, wedge shaped , lacy pattern 4. Mixed echogenicity nodular lesions aka 'target lesion' 5. Anechoic lesions
1. MYELOLIPOMA (or benign nodule hyperplasia, EMH, granuloma, hepatoma, infection, neoplasia) 2. lymphoma, histiocytic sarcoma, EMH 3. Infarct (or BNH, EMH, hematoma, infection, neoplasia) 4. Metastasis / EMH/ nodular hyperplasia 5. abscess, splenic pseudocyst (post haematoma) , cyst (uncommon)
50
a 6 year old female neutered DSH presents for further investigation of elevated ALT. Abdominal radiographs from the referring vet reveal a well-defined, tortuous, and tubular soft tissue opaque structure within the left mid abdominal cavity. What is your differential diagnosis for this?
spaghetti sign from splenosystemic shunt
51
you have a type AB cat but can't get AB blood, what's the next best option for transfusing this cat?
give type A (because type A cats have only low to moderate number anti-B antibodies
52
Define a major vs minor cross match
Major cross match - looking for recipient antibodies against donor RBC antigens Minor cross match- looking for donor antibodies against recipient RBC antigens
53
what should ideally be performed before a cat has a typed blood transfusion (even if never transfused before)?
cross-matching
54
how long can pRBC and FFP be stored?
pRBC - 20 d in citrus phosphate dextrose adinine (CPDA) , 35d in CPDA1 +optisol, 37d in CPDA-1 and adsol) FFP - 1 year in freezer marinated at -20 to -30 dc (frozen plasma can be stored for 5 years also but not fresh , so won't contain F 5 and 8
55
what does cryoprecipitate contain?
vWF, fibrinogen, fibrinonectin , factors 8 and 13
56
what is the definition of a massive transfusion?
administration of one blood volume or more in 24 hours, 50% of one blood volume in 3 hours, 150% of one blood volume regardless of time Blood volume- canine 80-90ml/kg feline 40-60 ml/kg
57
define relative , primary and secondary erythrocytosis?
relative - occurs when plasma water lost without concurrent loss RBCs (e.g. dehydration) primary - RBC production independent of EPO levels and EPO levels suppressed by adequate renal O2 delivery (as would expect) - only acquired (not congenital) described in veterinary patients - usually due to myeloproflierative neoplasia (polycythemia vera - mutation in JAK2 (V617F) Secondary - appropriate - chronic hyperaemia drives increased EPO production -> cardiac (R to L shunting most typical), congenital methaemoglobinaemia , high altudide, chronic CO poisoning, resp dz (incl obesity - pickwickian syndrome) inappropriate - elevated circulating EPO in the absence of hypoxia.- due to decreased renal blood flow causing renal hypoxia, or due to neoplastic dells producing EPO (nasal fibrosarcoma, schwanoma, cecal leimoyosarcoma, renal cell carcinoma, renal fibrosarcoma, renal sarcoma, renal lymphoma, renal nephroblastoma, splenic haemangiosarcoma) or endocrine dz (HAC, hypert4, HST)
58
what is the mechanism of action of hydroxyurea?
inhibits ribonucleotide reductase, inhibiting DNA synthesis and therefore cellular proliferation. Because HU blocks recycling of methemoglobin to Hb, can get methaemoglobinaemia (also can get reversible BM suppression, Heinz bodies (cats), macrocytocis, alopecia, nail sloughing)
59
what treatments may be considered in a patient with primary erythrocytosis that is refractory to phlebotomy and hydroxyurea?
In humans ruxolitinib (JAK1 and JAK2 inhibitor) utilised but is not recommended as first line therapy due to uncertainty regarding long term effects Oclacitanib is a JAK1 inhibitor but has some inhibitory JAK2 activity too and could be considered in patients with documented JAK2 mutation (but evidence lacking at present )
60
Which GI biomarkers are altered in greyhounds without GI disease
low b12 and folate, high homocystine
61
what treatment offers good success for idiopathic chylothorax without constrictive pericardial pathology?
thoracic duct ligation, 94% resolution rate
62
what novel treatment could be considered for cats with primary erythrocytosis with the hope of achieving erythrocyte destruction via Heinz body formation?
onion powder
63
What genetic defect has been identified in a cat with Glanzmanns thrombasthenia?
ITGA2B
64
What proportion of transfusion naïve critically ill dogs are crossmatch incompatible?
20% (dogs had similar rates of major CM incompatibility regardless of transfusion history. This suggests CM testing prior to transfusion be considered in all dogs however our study did not investigate clinical relevancy of incompatible LAB-CM.)
65
what technique can reduce storage lesions in whole blood?
single wash (multiple wash increase haemolysis)
66
Which interleukin builds up in non leukoreduced units
IL8
67
Which novel feline erythrocyte antigen associated with naturally occuring alloantibodies
negative FEA1
68
what is TRALI?
transfusion-related acute lung injury
69
What can reduce NETosis (neutrophil extracellular trap markers- may be involved in TRLALI) in stored canine pRBC?
leukoreduction
70
what proportion of cats receiving xenotransfusion have delayed hemolytic transfusion reaction?
64%, 1-6d post-xeno (median time for haemolysed serum or icterus was 2 days)
71
what is the mechanism of action of molidustat?
a hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitor - Mean HCT of molidustat-treated CKD cats increased weekly, and a significant increase compared to baseline (23.6%) was first observed on Day 21
72
What impact did epsilon-aminoacapreic acid administration have for dogs with severe thrombocytopenia?
none
73
how may PLT count differ between primary and secondary ITP?
lower in primary
74
when are IMPA cases most likely to relapse ?
in first 12 months (90% IMPA relapses happened in first 12 months vs 50% ITP relapses being in first 12 months and 56% IMHA relapses)
75
what diagnostic test may help differentiate central and peripheral thrombocytoepnia in dogs and cats?
immature platelet fraction
76
what is the mechanism of action of romiplostim?
thrombopoietin analog
77
what percentage of dogs with primary ITP experience an increase in PLT count after receiving romiplostim? What is the median time for PLT recovery >50x10^9/L and what is the median time for PLT count normalisation?
90% primary ITP dogs responded, median 4 days, normalisation median 7 days
78
what adverse effect should be considered possible in dogs even when receiving therapeutic doses of hydroxyurea (but likely rare)?
methaemoglobinaemia
79
how did response to immunosuppressive therapy compare between dogs treated with methylprednisolone alone versus either methylpred/cyclosporine or methylpred/mycophenolate
no difference

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