SAM.HI4: Non-Malignant Splenic Dz

Changes in RBCs seen w/ splenic dz (5)

Anemia.

Schistocytes.

Acanthocytes.

Spherocytes

nRBCs.

Schistocytes are highly suggestive of

Neoplastic splenic dz

nRBC can be seen w/

benign conditions such as EMH (spleen is not able to prevent release of immature cells when stimulated)

Leukoerythroblastic response

Increased nRBC and immature WBCs that can be seen w/ splenic dz.

Rads in Dx of splenic dz

size and position of the spleen.

evidence of effusion.

Generalized or focal splenomegaly on rads

may result in a mass effect in the mid-abdomen w/ displacement of other abdominal organs.

Rads w/ splenic torsion or hemorrhage (2)

decreased detail +/- effusion

torsion - abnormal placement of the spleen.

FNA is useful in the dx of dzs that cause

diffuse splenomegaly and some focal lesions

Which lesions have low yield w/ FNA

cavitated masses - not reco due to hemorrhage risk

Which method is often performed for cavitated lesions/hemorrhage

Splenectomy > splenic biopsy

Removal of the spleen may predispose animals to developing certain infections (3)

Mycoplasma spp.

E. canis.

Babesia canis.

Nodular Hyperplasia occurs as a result of

proliferation of normal cells of the spleen.

4 types of Nodular Hyperplasia.

Lymphoid.

Splenic stromal.

Hematopoietic.

Complex.

Which splenic pathology is a form of MH

Splenic myelolipoma.

Lesions of nodular hyplerplasia

focal, but there may be multiple.

Nodular hypoplasia on US

hypoechoic

How can nodular hyperplasia lead to hematoma in the dog?

distortion of the splenic vasculature by hyperplasia

Why is it suspected that cats are less likely to have splenic hematomas?

different anatomy of the spleen and orientation of the vasculature.

Splenic hematomas are more common in

large breeds - GSD and standard poodles.

Hematomas may occur

alone or be associated w/ MH, neoplasia, trauma, or idiopathic.

Clinical manifestation of dogs w/ hematomas

healthy

hemoabdomen

EMH occurs as the

workload of the spleen increases

Workload of the spleen increasing can be due to increased (4)

removal of normal cells.

activity of the mononuclear-phagocytic system.

activity of the lymphoid tissues.

blood cell production.

EMH on U/S (2)

Dogs - Diffuse splenomegaly that is hypoechoic.

Cats - diffuse nodular.

Aspirate results for EMH (2)

increased number of medium to large lymphocytes and plasma cells (hyperplasia).

increased number of blood cell precursors on splenic aspirates nRBCs peripherally may be seen.

Splenic congestion can be seen w/ (2)

acepromazine.

barbiturates.

Portal HT.

Venous HT - R sided HF and CaVC occlusion.

Splenic congestion on U/S

normal echotexture, but may have distended vasculature.

Splenic torsion spp trend

rare overall, but more common in dogs

CS of dogs w/ splenic torsion (4)

shock.

anorexia.

V.

Abdominal pain.

Torsion can rarely be

chronic and intermittent.

Rad findings of splenic torsion

decrease detail in the abdomen secondary to abdominal effusion.

U/S findings of splenic torsion (2)

Abnormal location.

Diffuse enlargement.

Tx for splenic torsion

Stabilization then Sx.

Splenitis def

Inflammation of the spleen.

Splenitis may result in

diffuse splenomegaly

What is formed during each phase of hemostasis (2)

Primary - platelet plug.

Secondary - Stable clot via fibrin.

Primary hemostasis CS (3)

Petechia and ecchymoses.

Blood from mm (can be either).

Bleeding immediately after venipuncture.

Secondary hemostasis CS (3)

RARE petechia and ecchymoses.

Bleeds into cavities.

Delayed bleeding after venipuncture.

Primary hemostasic disorders (3)

Thromboyctopenia.

Thrombocytopathia.

vWD.

Thrombocytopenia Etiologies- non-path (2)

Breeds - Cavaliers and Sight hounds.

Artifact.

Manual count of platelets (2)

Feathered edge.

Normal = 10-20/hpf.

BMBT tests for

thrombocytopathia (platelet function) or vWD - need to have a normal platelet number

Process for BMBT (4)

Lateral recumbency.

Lancing device.

Catch excess while not disturbing site.

2-4m.

Platelet fxn analyzer is used for dx of

congenital thrombocytopathia

vonWillebrand factor deficiency breeds

Doberman - up to 70% carry, type 1

Shetland sheepdog

Scottish terrier

German shorthair

Chesapeake bay

Golden

Bernese

Welsh corgi

GSD

Basset

vWD Type 1 (3)

Most common form.

Low quantity of factor.

Live normal lives.

vWD Type 2 (2)

More severe form.

Malformed factor, but has normal quantity.

vWD Type 3 (2)

Most severe form.

No factor produced.

CS of vWD (3)

Petechia and ecchymoses.

Epistaxis.

Peri-op bleeding.

(Hematuria, Hematemesis, and Melena)

Dx of vWD (2)

BMBT

Measure factor - detects Type 1 and 3.

Qualitative assay - detects Type 2 (measures binding vWF to collagen).

Tx for vWD - general concept based on type

Type 1 - may not bleed.

Type 2 and 3 - Tx.

Tx for vWD (3)

Desmopressin acetate.

Cryoprecipitate.

FFP.

Desmopressin acetate in tx of vWD

Type 1 and 2 given SC 30m prior to procedures.

Cryoprecipitate in tx of vWD

Has more vWF at lower volume. Given q8-12h.

Platelet dysfxn can be

congenital or acquired.

Dx of platelet dyfxn (4)

Bleeding w/ prolonged BMBT.

Normal vWF, platelet numbers, clotting times.

Abnormal platelet aggregation.

DNA tests.

Disorders of secondary hemostasis includes (4)

Vit K deficiency.

Hemophilia A or B.

Factor 12 deficiency.

DIC.

Etiologies of Vitamin K deficiency (4)

Rodenticide.

Inhibited Vit K production by intestinal microflora.

Liver dz - cholestasis.

Severe fat malabsorption (EPI, Biliary duct obstruction, Lymphangiectasia).

Pathogenesis of Rodenticide

Inhibits Vitamin K epoxide reductase resulting in loss of factor 2, 7, 9, and 10.

Dx of Vit K deficiency (3)

Exposure to rodenticide.

PT prolonged (36-72h) followed by PTT.

CBC suggesting hemorrhage.

Tx for Vit K deficiency - Early exposure w/ no bleeding (2)

Decontamination w/ emesis and charcoal.

Check PT at 36-48h post-exposure +/- Vitamin K.

Tx for Vit K deficiency w/ bleeding (3)

Plasma w/ red cells PRN.

SC or PO vitamin K x 2-4wks.

Measure PT 36-48 after completion

Hemophilia A and B inheritance

Autosomal X-lined recessive - males are affected

Dx of Hemophilia A and B (2)

Normal PT and prolonged PTT.

Measure factors.

Tx for Hemophilia A and B (2)

FFP for factors.

Red cells PRN.

(Can develop Ab's to transfused factors)

Factor XII deficiency is a common

intrinsic pathway deficiency in cats

Dx for Factor XII deficiency (3)

Normal PT and prolonged PTT.

Normal fibrinogen.

No clinical bleeding b/c clot does not depend on 12 (may have prolonged bleeding w/ hemorrhage).

IMT etiology general (2)

Idiopathic - more severe.

Associated or secondary.

IMT etiologies - Secondary (5)

HS - drugs and anaphylaxis.

ABX - sulfa.

Infection.

Neoplasia.

Systemic inflammatory.

IMT - infectious etiologies (5)

Anaplasma.

Neorickettsiae.

Babesia.

Erlichia.

Leshmania.

Dx for IMT (4)

Platelets <20k.

MPV may be increased.

Immune mediated or blood loss anemia.

Platelet Ab - intermittently available and does not differentiate primary v. secondary.

Tx for IMT - options (4)

RBC transfusion if anemic.

Glucocorticoids + adjunct.

Vincristine - premature platelet release (helpful in actively bleeding, unstable P).

Romiplastin - thrombopoietin receptor agonist.

Tapering for IMT (2)

GC: Taper q2wks w/ normal platelets by 25%

Adjunct: stop or taper once off pred.