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

2. 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
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3. 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
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
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4. 1000x
400x
200x
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5. 400x
400x
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6. Interpretation
Moderately regenerative anemia with marked spherocytosis consistent with immune-mediated hemolytic anemia
Inflammatory leukogram
Combo of pred and azathioprine
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7. 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
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8. Schalm’s Veterinary Hematology 2000, Fig. 118.1 pg 800
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Schalm’s Veterinary Hematology 2000, Fig pg 800

9. Schalm’s Veterinary Hematology 2000, Fig. 118.3 pg 803
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Schalm’s Veterinary Hematology 2000, Fig pg 803

10. 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)
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11. 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
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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, , 2002.
3. Weiss DJ and Brazzell JL. Detection of Activated Platelets in Dogs with Primary Immune-Mediated Hemolytic Anemia. J Vet Intern Med 20: ; 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: ; 2008.
Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only