Blood and Immune Disease
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What are the different types of blood and immune diseases?
- immune mediated hemolytic anemia
- immune mediated thrombocytopenia
- feline immunodeficiency virus
- feline leukemia virus
Describe how an animal gets immune mediated hemolytic anemia.
- decreased RBC lifespan
- RBC surface is coated with immunoglobulins
- these cells are removed by the immune system and destroyed by the spleen and liver
What causes IMHA?
- usually idopathic
- can be drug induced: trimethoprim sulfa, penicillin, methimazole (Tapazole)
What age and sex of dog do we usually see IMHA in? What time of year is mostly prevalent?
- dogs 2 - 8 years old
- 4X more prevalent in females
- most occur in the spring season
What are the clinical signs of IMHA?
- lethargy, weakness, depression
- pale mucous membranes
- +/- icterus, splenomegaly, hepatomegaly
How do we diagnose IMHA?
- CBC - will see regenerative anemia, spherocytes
- Coomb's test is positive in 35 - 70% of cases
How do we treat IMHA?
- glucocorticoids - prednisone is the drug of choice
- other immunosuppressive drugs alone or in combination
- splenectomy possible in dogs that do not respond to medical therapy
How do we educate clients on IMHA?
- prognosis is guarded
- 30 - 40% die regardless of treatment
- frequent rechecks of blood work are required
- relapses are common
What is Immune Mediated Thrombocytopenia (IMTP)? How does it happen in the body?
- destruction of circulating platelets, +/- megakaryocytes (in bone marrow, give rise to platelets)
- surface of platelet is usually covered with antibodies
- destruction in bone marrow, spleen, and liver
What are the causes of IMTP?
- may be drug induced: trimethoprim sulfa, penicillin, acetaminophen
What are the clinical signs of IMTP?
- petechial/ecchymotic hemorrhages in the gingiva and mucous membranes
- bleeding in GI tract (melena, hematemesis)
- urinary tract infections
- weakness, lethargy
How do we diagnose IMTP?
- platelet count usually under 30,000
- clinical signs
- response to treatment
What is the treatment for IMTP?
- prednisone - drug of choice
- can use in combination with other immunosuppressive drugs
- platelet rich plasma
- stop offending drug if drug induced
How do we educate clients on IMTP?
- platelet count must be monitored
- prognosis is guarded to good
- 20% of cases die
- possible splenectomy
- relapses occur
- monitor for hemorrhages on mucous membranes, abdomen
How should we handle patients with IMTP?
- do not draw blood from jugular
- apply pressure to venipuncture site for several minutes
- apply pressure bandage
- do not restrain patient in a brutal way
When was the first FIV virus isolated?
Where does the FIV virus start and where does it spread to? What does it have the ability to change?
- infection begins in lymph and salivary tissues and spreads to other tissues
- changes ability of lymphocytes to perform immune functions
What types of cats are more prone to being infected with FIV?
- outdoor, free-roaming cats
- more males affected than females
- middle aged to older cats, usually not kittens
- diagnosed between 6 - 8 years old
How is FIV transmitted?
- bite wounds
- blood transfusions
- kittens - lactating queens, in utero
- body fluids
What are the different stages to FIV?
- acute: 3 - 6 months
- subclinical: months to years
- chronic: months to years
What are the clinical signs of acute FIV?
mild clinical signs - fever, lethargy, generalized lymphoadenopathy
What are the clinical signs of subclinical FIV?
- usually no clinical signs
- however, the disease is still progressing
What are the clinical signs of chronic FIV?
- opportunistic infections throughout the body - slow healing wounds, persistent infections
- chronic upper respiratory infections
- chronic stomatitis
- chronic enteritis
- persistent dermatomycosis
- ocular disease (anterior uveitis)
- chronic wasting
- neurological signs
How do we diagnose FIV?
- ELISA - presence of antibodies
- sensitive and specific test
- false positives due to maternal antibodies
- retest kitten after 6 months of age
How do we treat FIV?
- antiviral drugs (expensive) - azidothymidine (AZT, Retrovir)
- supportive care
- no cure
How do we educate clients on FIV?
- progressive disease
- average life span after diagnosis is about 5 years
- test all new additions
- incidental infection among cats in a household is minimal
- FIV has not been found to grow in human cells
How do we manage a cat with FIV?
- confine to indoors
- good nutrition
- avoid raw eggs, meat, and unpasteurized milk
- routine parasite control
- immunosuppressive drugs used only if necessary
What is the FIV vaccine available through?
Can a cat test positive for FIV after getting the vaccine?
What does the FIV vaccine contain?
How is FeLV transmitted? Are kittens or adults more susceptible?
- fighting (saliva)
- shared bowls
- litter pan
- blood tranfusions
- surgical instruments
- needs close contact
- kittens more susceptible than aduls
What are the clinical signs of FeLV?
- weight loss
- tumors of lymphoid origin
- neurological signs
- secondary infections
How is FeLV diagnosed?
- ELISA, IFA tests
- CBC - nonregenerative anemia
- radiology/ultrasound - neoplasia in the chest
- tests of saliva/tears inaccurate
FeLV infection in newborns may not be detected until _____ after birth.
weeks to months
If the ELISA and IFA tests are positive for FeLV, what does that say about the disease?
highly likely to be persistently infected
Will the FeLV vaccine induce a positive test result?
What is the treatment for FeLV?
- no treatment
- symptomatic - fluids, blood transfusion, secondary infections
- antiviral therapy
- immunomodulators such as interferon
- chemotherapy for neoplasia
- appetite stimulants
How do we educate clients on FeLV?
- isolate from other cats
- keep indoors
- vaccinate for other feline diseases and rabies
- eliminate stress
- do not breed
- vaccinate other cats in household
_____ are all hematopoietic (blood cell forming) tumors for lymphoma in cats.
_____ of cases with cats who have hematopoietic lymphoma tumors are FeLV positive.
At what age is the onset of hematopoietic lymphoma tumors in cats?
- FeLV positive - 3 years old
- FeLV negative - 7 years old
Where do we usually find mediastinal lymphoma in cats? What age does it usually occur? What percent of cats are FeLV positive? What are the clinical signs?
- 2-3 years old
- mediastinal mass, respiratory signs and pleural effusion
Where do we usually find alimentary lymphoma in cats? Are these cats FeLV negative or positive? What are the clinical signs?
- in the lining of the intestine or stomach
- majority are FeLV negative
- vomiting, diarrhea, weight loss, intestinal obstruction
What is the most common form of lymphoma in cats?
What are the clinical signs of multicentric lymphoma in cats? Are these cats mostly FeLV negative or positive? What age do most of these cats get multicentric lymphoma?
- clinical signs vary with the size and location of the tumor, anemia due to FeLV, lymphadenopathy
- mostly FeLV positive
- 4 years old
How do we diagnose lymphoma in cats?
cytology: fine needle aspirate, lymph node biopsy, surgical or endoscopic biopsy, fluid cytology of effusions
How do we treat lymphoma in cats? What percent go into complete remission?
- chemotherapy: cyclophosphamide, vincristine, prednisone, cytosine - combination protocol is best
- 30 - 40% go into complete remission
How do we educate clients on lymphoma in cats?
- no cure
- goal is to induce remission
- life span of 2 - 42 months
- all will relapse eventually
- maintenance and follow-up is important
What is the most common hematopoietic tumor in dogs?
What is the average age of lymphoma in dogs?
6 - 7 years old
What are the clinical signs of lymphoma in dogs?
- regional or generalized lymphadenopathy (85% of cases)
- weight loss
- enlarged submandibular lymph nodes
How do we diagnose lymphoma in dogs?
- PE - lymphadenopathy
- lymph node biopsy is best
How do we treat lymphoma in dogs?
- chemotherapy - multidrug combination is best
- try to achieve remission
- radiation of solitary tumors
How do we educate clients about lymphoma in dogs?
- life expectancy is up to one year with treatment and 4 to 6 weeks without treatment
- most will eventually relapse
What is DIC?
- complex syndrome - not a specific disorder
- dynamic - patient's status and results of coagulation tests change "markedly, rapidly, and repeatedly" during treatment
- excessive intravascular coagulation leads to multiple organ microthrombosis and failure
- paradoxical bleeding caused by excessive consumption of platelets
Is DIC more common in dogs or cats?
What are the mechanisms that lead to activation of intravascular coagulation?
- endothelial damage: electrocution, heat stroke, sepsis
- platelet activation: viral infection (example FIV), sepsis
- release of tissue substances that promote blood coagulation: trauma, hemolysis, pancreatitis, bacterial infections, some neoplasms
What happens in DIC?
- microthromosis consumes platelets
- fibrinolysis is activated - leads to clot lysis, inactivation of clotting factors, and impaired platelet function
- normal tissue anticoagulation's are exhausted - used up
- fibrin is formed in the circulation, damages RBCs (schistocytes) and causes hemolysis
What are some primary disorders associated with DIC in dogs?
- liver disease
- immune-mediated blood disease
What are some primary disorders associated with DIC in cats?
- liver disease (mostly hepatic lipidosis)
- neoplasia (mostly lymphoma)
What are the clinical signs of DIC in cats?
clinical signs associated with primary problem - DIC found on lab testing - hemostatic values abnormal
What are the clinical signs of DIC in dogs?
- chronic - subclinical: lab signs
- acute: fulminant - profuse spontaneous bleeding, anemia, multiple organ failure, petechiae, ecchymoses, hemothorax
How do we diagnose DIC in dogs?
- hemolytic anemia, schistocytes, thrombocytopenia, neutrophilia with left shift
- increased bilirubin and hemoglobin in blood and urine (no not do cystocentesis)
- azotemia, hyperphosphatemia (renal microbemolism), increased liver enzymes, metabolic disease
- hypofibrinogenemia, increased FDPs (fibrin degradation products)
- prolonged clotting times - ACT, PT, PTT
- EKG may have multifocal PVCs
What is the treatment for DIC?
- treat underlying disease
- stop intravascular coagulation - heparin, transfusion (blood or plasma)
- aggressive fluid therapy to maintain organ perfusion
- prevent secondary complications - oxygen, correct acid-base disorders, antiarrhythmics, antibiotics
What is the prognosis for DIC?
- grave - mortality rate of 54%
- most dogs with DIC die of pulmonary or renal dysfunction
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