SA Immune Diseases

Question 1

how common are inherited neutrophil defects?

Answer 1

very rare

Question 2

how common are aquired neutrophil defects?

Answer 2

very common

Question 3

are innate or adaptive immune system deficiencies more common?

Answer 3

adaptive

Question 4

what is the most common inherited adaptive immune deficiency?

Answer 4

decreased Ab production due to decreased B cell function or lack of B cells

Question 5

what are the most common causes of acquired adaptive immune deficiencies?

Answer 5

Steroid therapy
Cushings
Diabetes Mellitus

Question 6

what diagnostics can you do to see initial clues of immune deficiencies?

Answer 6

history and CBC

Question 7

is IMHA usually primary or secondary?

Answer 7

primary

Question 8

classic CBC findings of IMHA

Answer 8

regenerative anemia
spherocytes
agglutination

Question 9

biochem findings of IMHA

Answer 9

hyperbilirubinemia

Question 10

Diagnostics for IMHA?
which is more specific?

Answer 10

Coomb’s test - direct anti-globulin test (detects IgG bound to RBC)
flow cytometry for RBC Ab (more specific)

Question 11

what is PIMA?

Answer 11

precursor targeted immune mediated anemia

Question 12

CBC findings of PIMA

Answer 12

non-regenerative anemia
no spherocytes
no agglutination

Question 13

will the Coombs test be - or + with PIMA?

Answer 13

negative

Question 14

Diagnostics for PIMA?

Answer 14

bone marrow aspirate and cytology
steroid trial

Question 15

diagnostics and treatment for PIMA?

Answer 15

bone marrow aspirate + cytology
steroid trial

Question 16

most common causes of death in dogs with IMHA?

Answer 16

anemia
thromboembolism

Question 17

how can you prevent thromboembolisms in patients with IMHA?

Answer 17

unfractionated heparin
low molecular weight heparin
clopidogel

Question 18

what are the three differentials for severe thrombocytopenia?

Answer 18

immune destruction
consumption
decreased production

Question 19

best diagnostic test for IMTP

Answer 19

flow cytometry for anti-platelet antibodies (APA)

Question 20

what is the mechanism of immune mediated neutropenia in dogs?

Answer 20

anti-neutrophil cytoplasmic antibodies (ANCA)

Question 21

what would you expect to find in a joint tap with polyarthritis?

Answer 21

95% non-degenerate neutrophils
supportive, non-septic inflam

Question 22

diagnostics for immune mediated neutropenia in dogs?

Answer 22

bone marrow aspirate and cytology

Question 23

key abnormalities for systemic lupus erythematosus

Answer 23

cytopenias
polyarthritis
proteinuria

Question 24

diagnostics for systemic lupud erythematosus?

Answer 24

antinuclear Ab (ANA)
joint taps
UPC
CBC

Question 25

is prednisone or dexamethasone more potent? which has a longer half life?

Answer 25

dexamethasone

Question 26

Mycophenolate MOA: side effects:

Answer 26

purine synthesis inhibitor - blocks T cell proliferation GI - vomiting, diarrhea

Question 27

Azathioprine MOA: side effects:

Answer 27

purine production & DNA synthesis inhibitor - blocks T cell proliferation hepatotoxicity (idiopathic hepatic necrosis)

Question 28

Leflunomide MOA: side effects:

Answer 28

pyrimidine synthesis inhibitor - blocks T cell proliferation GI toxicity, vasculitis

Question 29

Cyclosporine MOA: side effects:

Answer 29

blocks cytokine production GI toxicity in dogs, nephrotoxicity in cats

Question 30

Oclacitinib (Apoquel) MOA: indications? side effects?

Answer 30

Jax inhibitor = blocks signaling when cytokines bind to target cells adjunct therapy in autoimmune disease GI and bladder infection

Question 31

Intravenous Immune Globulines toxicity?

Answer 31

anaphylactic reactions

Question 32

steroid physiologic/replacement dose

Answer 32

0.05-0.1 mg/kg/day

Question 33

steroid anti-inflam dose

Answer 33

0.25 - 0.5 mg/kg/day

Question 34

steroid immunosuppressive dose

Answer 34

1-2 mg/kg/day

Question 35

how should you initially treat an immune disease?

Answer 35

high dose steroids (2mg/kg/day) + T cell targeted drug (cyclosporine, mycophenolate) after clinical remission, taper steroids first (50% dose reduction)

Question 36

how should you treat refractory immune disease cases?

Answer 36

rescue therapies - high dose methylprednisolone (10-30 mg/kg/day) - addition of oclacitinib (apoquel) - splenectomy

Question 37

when should you begin to taper steroids? by how much?

Answer 37

full clinical remission 50% dose reduction of steroids later taper T cell drugs