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Lymphoreticular system - specific diseases IMMUNE MEDIATED HAEMOLYTIC ANAEMIA (IMHA) IMHA is a disorder where autoantibodies against erythrocytes are produced, leading to erythrocyte destruction and anaemia. Immune mediated haemolytic anaemia may be primary (idiopathic) or secondary. Clinical signs????Lethargy, depression, weakness and collapse Tachypnoea Vomiting Diarrheoa Anorexia Pallor of mucous membranes Tachypnoea with haemic heart murmur Icterus Hepato or splenomegaly
Pale mucous membranes Pathogenesis??Idiopathic IMHA may be due to auto-reactive T cells, but the exact cause is unknown. Secondary IMHA may be due to vaccination, neoplasia or inflammatory disease, but it is often difficult to prove whether IMHA is secondary or not. Phagocytosis of opsonised red blood cells predominantly occurs extravascularly in the spleen, but may also occur intravascularly by blood monocytes. Cocker Spaniels, Miniature Schnauzers, Springer Spaniels, Poodles and Old English Sheepdogs are at an increased risk. Usually young to middle aged dogs are affected, and females are affected more than males.
Haemtological diagnostic signs include: regenerative anaemia, spherocytosis, concurrent leucocytosis, hyperbilirubineamia and elevated liver enzymes. Auto-agglutination test - mix one drop of saline with one drop of EDTA blood and examine for red blood cell clumping (positive test). Definitive diagnosis is by Coomb's test.
Positive saline agglutination test. Treatment?
Blood transfusion may be necessary to support the patient whilst treatment is initiated. Immunosuppressive doses of corticosteroids.
50-88% chance of survival. Death or euthanasia from ongoing IMHA or complications is a risk for the first 2 months.
NEONATAL ISOERYTHROLYSIS (KITTENS) Neonatal isoerythrolysis is an immune-mediate haemolytic disease seen in newborn horses, cattle, pigs, cats and rarely dogs. It is caused by ingestion of maternal colostrum containing alloantibodies to one of the neonate's blood group antigens. Clinical signs?Neonate is normal at birth, and signs may develop within hours of feeding or within a few days. Develops severe anaemia with weakness and icterus. Haemoglobinuria may be seen.
Caused by naturally occurring maternal anti-A alloantibodies in colostrum of blood type B queens. This results in immune mediated haemolysis of type A and type AB erythrocytes. NI is a major cause of fading kitten syndrome. BSH cats are more likely to have this disease due to the higher prevalence of type B queens. In contracts, DSH cats are less likely due to the low prevalence of type B queens.
DiagnosisDiagnosis is confirmed by screening of maternal serum, plasma or colostrum against paternal or neonatal red blood cells.
Treatment?A blood transfusion is reuiqred. The kitten must be fostered by a blood type A queen with milk or fed on a milk replacer. Supportive therapy.
PrognosisPrognosis is poor due to the acute course of the disease.
NEONATAL ISOERYTHROLYSIS (FOALS) Neonatal isoerythrolysis is an immune-mediate haemolytic disease seen in newborn horses, cattle, pigs, cats and rarely dogs. It is caused by ingestion of maternal colostrum containing alloantibodies to one of the neonate's blood group antigens. Clinical signs???Neonate is normal at birth. Develops severe anaemia with marked haemoglobinuria and haemoglobinaemia. Progressively lethargic, weak and depressed. Pale mucous membranes and later icteric. Breathing may become shallow, rapid and labored. Tachycardia may be seen. Shock leading to rapid death may occur within 6-8 hours post-partum.
Pathogenesis?Sensitisation of the mare's immune system to the stallion's red blood cell antigens occurs by blood leakage through the placenta during pregnancy or during birth, resulting in production of alloantibodies. Sensitisation after initial exposure (usually after the first pregnancy) is minimal. Repeated exposure to the same red blood cell antigens (i.e. after mating with the same stallion) occurs with subsequent pregnancies, increased alloantibody production. 90% of all NI cases in foals are associated with antibodies to blood groups Aa and Qa.
Coomb's test can confirm the diagnosis. The jaundiced foal agglutination test can be performed using the foal's blood and mare's colostrum before the foal suckles to prevent NI.
?????Immediately stop further ingestion of colostrum and replacement frozen colostrum, milk replacer or a foster mare.
?????Supportive care until foal recovers, including fluid therapy.
?????Blood transfusion. PrognosisPrognosis is poor due to the acute course of the disease.
BABESIOSIS (CANINE) Babesiosis is caused an intracellular protozoan parasite of erythrocytes of the genus Babesia. The disease is tick-borne and can affect a range of animals including cattle and dogs. In dogs, Babesia canis or Babesia gibsoni are causative organisms of canine babesiosis, although Babesia gibsoni is rare in the UK. B. canis is transmitted by Dermacentor reticulatus, whilst B. gibsoni is transmitted by Rhipicephalus sanguineus. Clinical signs Canine babesiosis can be classified into complicated and uncomplicated forms?
- Haemolytic anaemia - regenerative.
- Fever, anorexia, depression, pale mucous membranes and splenomegaly. Complicated form:
- Systemic inflammatory response syndrome (SIRS)
- Multiple organ dysfunction syndrome (MODS)
- Renal, cerebral, hepatic and respiratory signs may be seen.
PathogenesisIntra-erythrocytic parasitemia causes both intravascular and extravascular haemolysis, resulting in regenerative anaemia.
DiagnosisBlood smear examination using Romanowsky stain. B. canis appear as pear-shaped organisms that are usually paired, and B gibsoni as smaller, round to oval single organisms.
TreatmentAntiparasitic drugs such as
Diamizine given at 3.5mg/kg as a single IM dose. It has rapid action but a short lived protective effect. Toxicity can cause irreversible neurological deficits and can be potentially fatal.
- Imidocard given at 6mg/kg IM or SC. Toxicity can cause renal tubular and hepatic necrosis. Supportive therapy should be given for dehydration and anaemia. A blood transfusion may be required depending on the case.
PrognosisPrognosis is guarded.
BABESIOSIS (BOVINE) Babesiosis is caused an intracellular protozoan parasite of erythrocytes of the genus Babesia. The disease is tick-borne and can affect a range of animals including cattle and dogs. In cattle, babesiosis is also known as Redwater fever. In the UK, Babesia divergens is the most common species. It is transmitted by Ixodes ricinus. Babesia major occurs in the south east of England but is not pathogenic. It is transmitted by Haemaphysalis. In tropical and subtropical regions, Babesia bovis causes disease and considerable losses in the cattle industry. Here the vestor is Boophilus. Clinical signs???
Depression Pyrexia 'Pipe stem' diarrhoea that later develops to constipation. Haemoglobinuria. Pale mucous membranes. Abortion in pregnant cows.
Pathogenesis?Intra-erythrocytic parasitemia causes both intravascular and extravascular haemolysis, resulting in regenerative anaemia. Cattle develop specific immunity after infection. Calves under 1 year old may become infected but are less likely to show clinical signs due to innate resistance.
History and clinical findings. Examination of blood smear with Romanowsky stain can confirm diagnosis.
Mild cases may not require treatment. Antiparasitic drugs
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