Immune mediated 2

type II hypersensativity
Ab against cell or cellular constituents (cell surface, cell receptor)

activation of self directed Ab =viral/ bacterial infection triggers immune dysregulation (primary)
Innocent bystander= Ab directed against infectious agent or drug that is assoc with cell surface (secondary)

fever, complement mediated, ACUTE ONSET, hemogobinuria, hemoglobinemia, weakness, anorexia, vomiting, anorexia, diarrhea, pallor, NON- REGEN (too early, need 1-3 days for BM to work)

fever, removel by RE sysem, SUBACUTE ONSET, weakness, anorexia, ICTERUS, pallor, SPLENOMEGALY, REGEN (bone marrow already working)

primary immune mediated hemolytic anemia,

may be primary or secondary

IMHA and ITP (usually primary)

autoagglutination (clumping of RBC after binding by Ab)
intravascular hemolysis

intravascular hemolysis

extravascular hemolysis
SPEROCYTE
MOST COMMON FORM IN DOG

Cold agglutination
intravascular hemolysis

extravascular agglutination under cold condition

depression, lethargy, weakness, syncope (loss of conciousness, fainting)
pale mm, icterus
spleno- hepatomegaly
lymphadenopathy
PYREXIA (fever)
vomiting
PTE (pulmonary thromboembolism(
DIC (disseminated intravascular coagulaiton)

CYANOSIS, necrosis, gangrene
on ear tip, nose, tail, distal extremities

most common in dog
may be assoc with infection
SLE
idiopathic

most common in cats
drugs (methimazole, pencillin, sulfonamide, procanimide, cephalosporin)
neoplasia
rickettsia dz
mycoplasma haemofelis
Babesia
Cytauzoonosis
lepto
VX
zinc- pennies, bolt
toxin

any dogs or cats
any age
Female> male
2-7 yr most common
breed predisposed: american cocker, english springer spaniel, old english sheep dog, irish setter, poodle, german shepard

min database
CBC- HCT/ PCV retics count, SPHEROCYTOSIS
chem panel- incr. liver enzyme, increase bilirubin
UA- intravascule- hemoglobinuria and proteinuria, extravascular- bilirubinuria (cause icteric)

slide agglutination
COOMB'S TEST- only if slide agglut. test neg
should consider cross match
test for possibel causes- rads, tick panel(rickessial), FeLV, FIV

place a drop of EDTA blood on a slide
examine at RT and 4 degree C

unnecessary w/ regen anemia
erythroid hyperplasia indicate refen
myelofibrosis (replacement of BM w/ fibrous tissue)C or RBC aplasia seen with nonregen

Direct Coomb's test- detect IgG, IgM or C3 bound to RBC
combine whole blood with species specific agent and look for agglutination

recent transfusion

Ab vs. precurson not cell
drug dependant
steroid admin

invalid, detects Ig og C bind to exogenous RBC/ Ag complex

ELISA
detects Ig bound to RBC

flow cytometry
detects Ig bound to RBC

detect IG bind to nuclear component

serology, culture
test FeLV

stop hemolysis
maintain tissue oxygenation
provide adequate perfusion
manage potential side effect

1. glucocorticoid- PU/PD, weight gain, hair loss, iatrogenic cushingss
2. azathiprine- $, NOT IN CATS
3. Cyclosporin- $$$$
4. If doesn't work- IV human Ig- $$$
5. cyclophosphamide and splenctomy not demonstrated to have benefit

maintain adequate tissue oxygenation while waiting for response
1. plasma RBC transfusion

prevent sludging of blood
decrease organ damage and risk of DIC
IV FLUIDS

Thromboembolism (clot in blood vessel) and DIC
low dose asprin (best evidence)
low molecular wt heparin (some evidence)
unfractionated heparin (not proven)

decrease albumin- bad
incr bilirubin- bad
age- older, bad
RESPONSE TO THERAPY (most impt), continue autoagglutination bad, need to add meds to get it under control

gradually tapered meds (pred 1st cause of side effect)
recheck PCV q 7-14 days initially and then 4-6wks
even after off meds, need CBC q 6-12 m for life
AVOID INITIATING CAUSE

Primary: SLE, idiopathic
Secondary: HW, neoplasia, lepto, FeLV/ FIV/ FIP, modified live vx, leishmania, mycoplas,a haemoflis, Ehrlichiosis, Rickettsia, Babesia, Cytauxzoon, drugs

any dog or cat
any age but F>M
2-7 yr most common
breed (american cocker, english springer spaniel, english sheep dog, german shepard, poodle)

Petechiae
ecchymosis (bruise)
hyphema
epistaxis- unilateral or bilateral
fever
lethargy
GI bleeding- melena (black tarry stool) and hematechezia (frank blood stool)

CBC: throbocytopenia, incr. # of giant platelet
serum chem
coag test to evaluae DIC
tick titer
imaging for neoplasia
check vx and drug history

platelet Ab testing
serology (tick titer)
Chem, UA, rads, US, culture, PCR, ANA

stop platelet destruction
reduce blood loss
maintain tissue oxygenation if bleeding severe
provide adequate perfusion

1. glucocorticoid
2. Azathioprine (not in cats)
3. Cyclosporin
4. Intrvenous human Ig
5. cyclophosphamide and splenectomy not demonostrated benefits

cage rest to reduce trauma
GI protectant (sucralfate, famotidine)
minimize venipunture and avoid large veins
minimize other percutaneous procedures (think b4 aspirating the LN)

tranfusion if needed (whole blood if possible)
monitor for development of IHA

IV fluids
blood pressure

questionable platelet functions and limited availability

70% responsive to tx
poorer prgonosis if pt has Evan's dz (IMHA and ITP) or severe blood loss
25% recurrece rate