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Immune-Mediated Hemolytic Anemia in an American Cocker Spaniel

Immune-Mediated Hemolytic Anemia in an American Cocker Spaniel. Peter Christopherson 1 , Elizabeth Welles 1 , Ellen Behrend 2 , and Elizabeth Spangler 1. Auburn University College of Veterinary Medicine, Department of Pathobiology 1 and Department of Clinical Sciences 2.

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Immune-Mediated Hemolytic Anemia in an American Cocker Spaniel

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  1. Immune-Mediated Hemolytic Anemia in an American Cocker Spaniel Peter Christopherson1, Elizabeth Welles1, Ellen Behrend2, and Elizabeth Spangler1 Auburn University College of Veterinary Medicine, Department of Pathobiology1 and Department of Clinical Sciences2 http://www.zimfamilycockers.com/ Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  2. Signalment & History: 3-year-old, spayed female, American Cocker Spaniel Dark red urine for 3 weeks Pruritic with sore footpads Tx: Antibiotics & Ketoconazole Physical Exam: Lethargy and mild weight loss Pruritic dermatitis “Dirty ears” Prominent popliteal lymph nodes Diagnostics: CBC, chemistry panel, coagulation profile Urinalysis with aerobic culture Thoracic/abdominal radiographs and abdominal ultrasound Aspirate of popliteal lymph nodes Titers and PCR for tick borne diseases Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  3. Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  4. 200x 400x 1000x Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  5. 400x 400x Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  6. Interpretation • Moderately regenerative anemia with marked spherocytosis consistent with immune-mediated hemolytic anemia • Inflammatory leukogram Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  7. IMHA • Primary or secondary • Predilections: breed, sex, age, blood type • RBC destruction • IgG, IgM, or complement • Spherocyte formation • Intravascular hemolysis Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  8. Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only Schalm’s Veterinary Hematology 2000, Fig. 118.1 pg 800

  9. Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only Schalm’s Veterinary Hematology 2000, Fig. 118.3 pg 803

  10. Laboratory Findings • Anemia usually regenerative • Spherocytes • Inflammatory leukogram • Thrombocytosis or thrombocytopenia • May see hyperbilirubinemia/icterus • +/- evidence of intravascular hemolysis Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  11. Normal RBC Spherocyte Spherocytes • Loss of RBC membrane without loss of cell volume • Partial phagocytosis • Identifiable on canine blood smears • Cells are round with smooth margins • Decreased diameter and central pallor • Ddx: snake envenomation, bee sting, zinc toxicity, inherited membrane or enzyme defects Bessis M: Blood Smears Reinterpreted, Springer-Verlag, 1977, pgs 53 & 97 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  12. Acknowledgements & References Uschi Wohlfert, Debbie Czerkawski, Amy Hall, Donna Shiver, and Stephany Spencer 1. Latimer KS, Mahaffey EA, and Prasse KW. Duncan & Prasse’s Veterinary Laboratory Medicine Clinical Pathology, 4th edition. Iowa State Press, 17, 2003. 2. Stockham SL and Scott MA. Veterinary Clinical Pathology, 1st edition. Iowa State Press, 122-126, 2002. 3. Weiss DJ and Brazzell JL. Detection of Activated Platelets in Dogs with Primary Immune-Mediated Hemolytic Anemia. J Vet Intern Med 20: 682-686; 2006. 4. Piek CJ, Junius G, Dekker A, Schrauwen E, Slappendel RJ, and Teske E. Idiopathic Immune-Mediated Hemolytic Anemia: Treatment Outcome and Prognostic Factors in 149 Dogs. J Vet Intern Med 22:366-373; 2008. Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

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