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Haemolytic Anaemia - a case study
Kong Yuen, BVMS (Glasgow), MRCVS
25 November, 2010
Be Kind To Pets
Today, Thursday at 9.30
am, the lady owner will be bringing
the Miniature Schnauzer with white
gums, 2 weeks after treatment. It is
4.36 am now and I am reviewing the
case of this dog. A case of the dog
with white gums.
first report is at:
So far, the lady said that the dog's
gums had become pinker. The dog is
eating and drinking and passes normal
stools and urine. Her only complaint
was that the dog had this panting
throughout the day during the past 2
weeks. She said: "She may be feeling
Well, the dog did have a very painful
slipped disc when I first checked her.
She also had a painful bladder area on
What is the cause of this panting? Is
the old dog with white gums suffering
from a form of an autoimmune
haemolytic anaemia (AHA)? In AHA, the
dog's red blood cells are produced
normally but its abnormal antibodies
which are needed to destroy bacteria
or viruses, start destroying the red
blood cells. So, the dog has low red
blood cells and suffers from anemia.
In AHA, the dog also has low numbers
of platelets and suffers from
thrombocytopenia. The platelets in the
blood form clots when blood vessels
are cut or broken. If the dog has low
platelet count, there will be
uncontrolled bleeding. AHA in dogs is
similar to haemopilia in people.
Anaemia. Pale or white gums,
conjunctiva and later yellow instead
of normal pink to red colour. So the
dog is lethargic as it has low levels
of oxygen in the tissues and brain.
Jaundice. The liver removes the
damaged red cells. The breakdown
products causes a yellow colour of
gums, conjunctiva and skin.
Bleeding from the nose or blood in the
stools due to low platelet count.
Takes a longer time for bleeding to
Heart beats faster to bring oxygen to
the tissues and brain.
1. COOMBS TEST is used to check
for antiglobulins (autoantibodies).
Nearly 98% of human patients with AIHA
have a positive direct Coombs test
(also known as direct antiglobulin
test or DAT). A positive DAT means
that the red blood cells are coated
with the red blood cell
autoantibodies. Patients may only have
a positive direct Coombs test during
disease flares and not at all times.
There is also the Coombs
Negative AIHA as a result of
vaccinations or other medical
conditions and the patient is
mis-diagnosed as having other types of
anemia or non-immune haemolytic
2. BONE MARROW BIOPSY
AIHA may be either regenerative or
non-regenerative as determined by a
lab examination of a blood sample
and/or bone marrow biopsy.
Regenerative anaemia - increased
numbers of large immature red blood
Non-regenerative anaemia - anaemia
lasting >5 days with low
reticulocytes; the immature red cells
are made but are destroyed in the bone
marrow by the dog's own immune system.
As Vet 1's blood results did not
include platelets (IDDEX machine had
printed out an advice to repeat blood
test), so there was no earlier blood
test history in relation to RBC, HB
Dogs with chronic AIHA take many weeks
to show clinical signs as in this
A bone marrow biopsy is used to
between non-regenerative AIHA and
cancer or other causes of
non-regenerative haemolytic anaemia.
But few vets do this bone marrow
biopsy and diagnose the dog with
chronic non-regenerative AIHA as
suffering from blood cancer, according
to one dog forum posting (see
IN THE CASE OF THE DOG WITH WHITE
GUMS, it was difficult to collect the
urine for analysis of the presence of
haemoglobin in the urine. The dog was
in great pain and I stopped
catherisation of the urethra for
urine. She peed the normal yellow
urine instead of the dark red urine in
Genetic or environmental factors. The
latter include infections, drugs,
poisons, bee stings and vaccines.
Various neoplasms, systemic lupus
erythematosus and canine
The dog had not been vaccinated for
the past few years and so vaccination
would not be the cause. The dog was
recently taken outdoors after living
in the apartment for most of her life.
Infections could be the cause.
Some indications of infections include
ulcers at the back of the tongue on
the left side. (I took a picture 24
hours after IV treatment when I
examined the tongue and tonsils). At
the first consultation, the dog wanted
to bite me when I palpated the
enlarged left submandibular and
popliteal lymph nodes.
Tumours. Since the dog had been losing
weight of 25% for the past 4 weeks
(from 5kg to 4kg), it could be
suffering from internal tumours, e.g.
in the spleen, pancreas or liver as
"diagnosed by ultrasound" by Vet 1
Gender. Females of all breeds, even
when spayed, have a higher risk for
AHA than males.
Genetic predisposition. Some dogs have
changes in their immune system, a
deficiency of pyruvate kinaese enzymes
or abnormal red blood cell structure.
Breeds at higher risk. American Cocker
Spaniels, Beagles, Old English
Sheepdog, Westies, Shih Tzus, Alaskan
Malamute, Lhasa Apso, Poodles,
Basenjis, Daschunds. The case being
reviewed is a Miniature Schnauzer,
TWO BLOOD TESTS WITHIN 24 HOURS.
Low red cell counts, low haemoglobin
and lower platelet count.
In theory, the haemoglobin should be
high if there is AHA. This is because
the destroyed red cells will lead to
an increase in haemoglobin and not to
However total white cells were in the
normal range. I noted that the % of
neutrophils was over 90% (normal dog
is usually around 75%). The dog
responded to baytril IV, metronidazole
IV, Vit K1 IV and dexamethasone 0.2 ml
IV, iron SC and Vit B complex SC on
day 1 as the gums became pink 24 hours
1. Most dogs with AHA respond to
steroid therapy which may be required
for years. Prednisolone suppresses the
immune system to prevent red blood
cell destruction. Bacterial, viral and
fungal infections must be treated if
Oral prednisolone in high doses e.g.
2-4mg/kg q 24hr divided into 2X/day,
starting at 2 mg and increasing dosage
if response is poor. Give for 2-
weeks, then gradually taper off
dosage. Decrease to mg/kg/24 hours for
2-4 weeks, then 1 mg/kg/48 hours for
2-4 weeks, then taper off.
*If anaemia (one author in a dog's
forum uses PCV as below 12% as
unstable, PCV 35-55% as stable). If
unstable, go back to previous dosage
that works, according to one
2. A gastroprotecant e.g. sucralfate
(0.5-1g) given when the dog is on high
doses of steroids.
medications like cyclophosphamide
together with lower dosage of steroids
for severe AIHA, for several months
and reassess 2-4 weekly. Most dogs
respond to prednisolone and
immunosuppressant. If there is a
relapse, a longer course of medication
may be required.
Cyclophosphamide (50mg/Ma p/o q 24 hr)
or 2 mg/kg q 24hr for the first 4 days
of each week for 6-8 weeks. Re-assess.
Azathioprine (50mg/Ma q 24hr)
(2mg/kg p o q 24 hr) for 1-2 weeks,
then every other day.
Cyclosporin (15mg/kg po q 24hr) has
been used to treat refractory AIHA.
Danazol (synthetic androgen, 5 mg/kg
po q 12 hr). Expensive. Reserved for
dogs that have are refractory to pred
+ cyclophosphamide or Azathioprine or
intolerant drug side effects.
Contraindicated in dogs with heart,
liver or kidney problems.
3. For severe cases, splenectomy
(last resort in life-threatening
refractory anaemia if medical
treatment is not controlling the
disease after 4-6 weeks of therapy).
Blood transfusions and intravenous
immunoglubulin therapy. Blood
transfusion may be needed in the very
severe anaemic dog to buy time for the
drugs to act. Use cross-matched packed
red cells only and these cells may
also be destroyed by the dog's immune
Reference to an internet article at:
I will update the case of
the dog with white gums as soon as
Will discuss with the owner today:
1. Blood test
2. Coombs' test
3. Urine test
4. Prednisolone + Immunosuppressant (cyclosporin)
for next 2 weeks.
5. X-rays or ultrasound of chest and
7. No bone marrow biopsy
KIND TO OLDER DOGS & CATS --- GET TUMOURS REMOVED
EARLY --- WHEN THEY ARE SMALLER. More case
make an appointment: e-mail
tel: +65 9668-6469, 6254-3326
Be Kind To Pets
All rights reserved. Revised: November 25, 2010
Toa Payoh Vets