Immune Medidated Disease

Question 1

Platelet formation is mediated through ________ which is produced in the liver and kidney

Answer 1

Thrombopoietin

Question 2

What is the hallmark clinical sign of immune mediated thrombocytopenia ?

Answer 2

Surface bleeding — petechiae, ecchymosis, and epistaxis

Question 3

Platelet count is below _______ when petechiae and ecchymosis are present

Answer 3

30, 000/mcl

Normal is 200 000 to 500 000

Question 4

T/F: VonWillebrands disease rarely causes petechiae, but does cause bleeding post-surgery or trauma

Answer 4

True

Question 5

You have a prolonged mucosal bleeding time but your platelets, PT, and aPTT are all normal..

What would you suspect as you dx?

Answer 5

VonWillebrands dz

Question 6

How do you diagnose vonWillebrands dz?

Answer 6

ELISA plasma

DNA testin

Question 7

Treatment for vonWillebrands dz?

Answer 7

Desmpressin — improve hemostatic fxn

Blood components - fresh whole blood, FFP, cryoprecipitate

Question 8

Primary ITP is caused by?

Answer 8

Antibodies bind to platelet —> destruction

Antibodies are targeted against GpIIb/IIIa fibrinogen receptor

Reduction in T regulatory cells

Question 9

T/F: most cases of ITP is secondary

Answer 9

True

Question 10

Causes of secondary ITP?

Answer 10

Drug - sulfonamide, cephalosporin, carprofen

Infectious

Neoplasia

Inflmmatory dz

Toxins

Question 11

You do a CBC on your suspected immune mediated thrombocytopenia case, platelet count is <150,000. How can you determine this is a real thrombocytopenia?

Answer 11

Blood smear to rule out clumping of platelets

Question 12

Treatment of ITP?

Answer 12

Immunosuppression
- remove cause

• glucocorticoids
• vincristine and hIVIG —> induce platelet release from megakaryocytes and shorten severe thrombocytopenia

Question 13

How does Human IV IgG treat ITP?

Answer 13

Block macrophage from phagocytosis platelets

—> no difference between use of vincristine and this

But this agent is very expensive

Question 14

What additional therapy for ITP can you use if glucocorticoid therapy fails?

Answer 14

Azathioprine

Question 15

What is the best first line treatment for ITP if glucocorticoids are contraindicated?

Answer 15

Mycophenolate mofetil

Question 16

You have ITP with a severe anemia, in addition to drug therapy, what can you do to stabilize the patient?

Answer 16

Platelet transfusion

Fresh whole blood —> best source of platelet in practice

Fresh platelet rich plasma

Lyophilized platets

Question 17

What is the prognosis for ITP?

Answer 17

Good

93-97% survivial rate

Question 18

What is the prognosis for dogs suffering form Evans syndrome/

Answer 18

Poor - IMHA + ITP

76% death rate within 30 dy\ays

Question 19

What is a polyarthropathy?

Answer 19

Neutrophilic inflammation of multiple joints

Question 20

Clincial signs of a immune-mediated polyarthritis?

Answer 20

Animal is reluctant to walk
Shows stiffness
Systemic illness

Question 21

DDX for immune mediated poly arthritis?

Answer 21

Infectious - rickettsia, bacteria, Mycoplasma, fungi, andviral

Reactive

• drug
• neoplasia
• vaccination
• infectious focus (non-joint)
• inflammatory focus, enteropathy or hepatopathy

Primary immune mediated - erosive or non erosive

Question 22

How can you diagnose immune mediated poly arthritis?

Answer 22

Multiple joints affected
Fever of unknown origin
Neutrophilic inflammation of the synovial fluid

Rule out

• tick
• single joint culture
• systemic dz/ neoplasia
• culture affected joins
• local fungal dz

Question 23

What are causes of non-erosive primary ITP?

Answer 23

Systemic lupis erythematosus (SLE)

Breed associated
- shar pei —> hyaluronic acid os over expressed

Idiopathic

Question 24

You have a non-erosive primary ITP, how can you determine if it is idiopathic or not?

Answer 24

Idiopathic occurs in animals 3-7yrs

Rule out SLE or other secondary causes
Liver biopsy - hetaptomegaly
Renal biopsy if evidence of proteinuria

Thoracic rads and abdominal US

Antinuclear antibody Tigre and rheumatoid factor

Question 25

Treatment for idiopathic, non-erosive primary IMP?

Answer 25

Corticosteroid
Mycophenolate mofetil
Luflenomide

Cat - chlorambucil

Question 26

Causes of an erosive primary IMP?

Answer 26

Breed
Feline periosteal proliferative arthritis

Rheumatoid arthritis

Question 27

How does rheumatoid arthritis appear in radiographs?

Answer 27

Inflammation, articular cartilage loss, erosion of periarticular bone and joint deformation

Question 28

What is systemic lupus erythematosis?

Answer 28

At least two separate manifestations of autoimmunity

AND

Presence of antinuclear antibodies — directed against a wide range of nuclear, cytoplasmic, and cellular membrane molecules

Question 29

What are causes of SLE?

Answer 29

Genetics

Environmental factors

• UV light
• estrogen and prolactin
• decreased allergy exposure

Drugs

Infections agents - eg FeLV and FIV

Question 30

Signalment for SLE ? And main presenting complaint?

Answer 30

Dog 3-7yrs
Cats 1-11yrs

Lameness - dogs

Question 31

What are the specific tests for SLE?

Answer 31

Lupus erythematosus cell test —> LE cell is a neutrophil containing phagocytosed nuclear material

Antinuclear antibody (ANA)

Question 32

What pathology can be associated with SLE?

Answer 32

Cutaneous lesions - depigmenttion, erythema, erosions, and ulcers

Oral ulcer

Arthritis - non erosive non-specific arthritis of two or more joints

Renal disorder - glomerulonephritis

Anemia/thrombocytopenia/leukopenia
Polymyositis/myocarditis
Serositis
Neuro disorders

Question 33

SLE treatment?

Answer 33

Immunosuppression

• pred
• some cats dont respond to pred —> try triamcinolone/dexamethasone
• mycophenolate mofetil (dog)
• chlorambucil (cat)
• always monitor for proteinuria and glomerulonephritis