Haemolytic Anaemia

Question 1

What could suggest haemolysis?

Answer 1

Red plasma at HCT
Increased bilirubin
Haemoglobinuria
Bilirubinuria

Question 2

What are the two parasites that cause the mononuclear phagocytic system to phagocytose RBCs?

Answer 2

Babesia canis in imported dogs or those with ticks

Mycoplasma felis

Question 3

What causes intravascular haemolysis?

Answer 3

DIC
Hemangiosarcoma
Zinc toxicity from ointment or metal
Hypophosphataemia from treatment with insulin

Question 4

What is special about cats with IHA?

Answer 4

Usually secondary to parasites, methimazole (triggers immune) or oxidant damage

• mycoplasma
• paracetamol
• methionine
• propylene glycol

Question 5

What should be excluded before accepting a diagnosis of primary immune mediated haemolytic anaemia?

Answer 5

RBC parasites
Drugs
Zinc from ointment or metal

Question 6

What are the three things almost pathognomonic for IMHA in a clinically ill dog?

Answer 6

Polychromasia
Autoagglutination
Spherocytosis

Question 7

What are the principals of treatment of IHA?

Answer 7

Immunosuppressive corticosteroid
If deteriorating rapidly cyclophosphamide 200-300mg/m2 PO

High risk for DIC or thrombosis
low dose heparin 50iu/kg SC q8
Aggressive fluids flush RBC aggregates from microcirulation

Question 8

What indicates the need for transfusion and what are the complicating factors?

Answer 8

Orthopnoea
Dyspnoea
Tachypnoea

False positives on typing card for DEA 1.1
Universal PRC should be used if available

Question 9

What should be remembered when starting transfusion?

Answer 9

Pretreat with dexamethasone 0.5-1mg/kg IV
Give fluids through another IV
Continue heparin or aspirin
Cross matching is indicated