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

3-year-old, spayed female, American Cocker Spaniel 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 Keto 1 week prior to referral Talk about how they were working up multiple problems…thus all the diagnostics Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Patient Value 4/18/07 Ref Interval Parameter Patient Value 4/18/07 Ref Interval HCT (%) 22.4  37-55 MCV (fL) 78.8  60-77 MCHC (g/dL) 27.7  32-36 RDW 18.3 11-17 Platelets (/uL) 227,000 164,000-510,000 MPV (fL) 16.6 8.4-13 Reticulocyte % 11.26 0-1.5 Reticulocyte Count (/uL) 320,000 0-60,000 Nucleated RBC(/100 WBC) 5 WBC (/uL) 57,040  6,000-17,000 Neutrophils (/uL) 44,491  3,000-11,400 Bands (/uL) 3,993  0-300 Monocytes (/uL) 6,274 150-1,350 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

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

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

Interpretation Moderately regenerative anemia with marked spherocytosis consistent with immune-mediated hemolytic anemia Inflammatory leukogram Combo of pred and azathioprine Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

IMHA Primary or secondary Predilections: breed, sex, age, blood type RBC destruction IgG, IgM, or complement Spherocyte formation Intravascular hemolysis IgM: gross agglutination Breeds: cockers, poodles, collies, sheepdog Sex: females slightly more than males Associated with: vaccines, infections, neoplasia, bee stings, zinc toxicosis, drugs (penicillin, TMS, levamisole, amiodarone Spheres: shortened half life Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

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

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

Laboratory Findings Anemia usually regenerative Spherocytes Inflammatory leukogram Thrombocytosis or thrombocytopenia May see hyperbilirubinemia/icterus +/- evidence of intravascular hemolysis Talk about inflammatory (hypoxia, tissue damage) Platelets (DIC, TE dz) Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Spherocytes Loss of RBC membrane without loss of cell volume Normal RBC 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 Spherocyte Say redundant membrane Say RBC has redundant membrane Incomplete spherocytes Bessis M: Blood Smears Reinterpreted, Springer-Verlag, 1977, pgs 53 & 97 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

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