Page 6 - Clinical Connections - Spring 2022

RVC RESEARCH STUDY VETERINARY SERVICES RVC.AC.UK
Case Study

IMMUNE-MEDIATED HAEMOLYTIC ANAEMIA

Erica Tinson, Lecturer in Veterinary Emergency and Critical Care

uddy, a six-year-old Labrador was in the evaluation of underlying causes of IMHA and steroid treatment. Clopidogrel
presented to RVC Small Animal his disease and the transfusion medicine and rivaroxaban were started to treat
B Referrals in early January for team needed to be intimately involved to this hypercoagulable state. Owners and
investigation of severe anaemia. effectively plan for his blood products. referrers were therefore advised to expect
He was diagnosed with immune-mediated Buddy required packed red blood cell Buddy to display intermittent tachypnoea.
haemolytic anaemia (IMHA), which, in the transfusions on five occasions from the 8th He is likely to need to anticoagulant therapy
absence of evidence of a trigger factor, of January. Due to a high level of transfusion until his inflammatory state has resolved,
was considered to be non-associative dependency and clinical deterioration, which will be marked by his IMHA going into
(idiopathic). he also underwent therapeutic plasma remission.
During physical examination, Buddy exchange. He had 10 units of red blood cells Buddy developed an abscess of this right
was quiet but alert and responsive. His – which had the transfusion team working thoracic limb while in hospital. It is suspected
mucous membranes were pale and icteric very hard to keep up with the demand – and to be associated with a previous intravenous
and capillary refill time was two seconds. eight plasma transfusions. catheter. Fortunately, Buddy responded well
His sclera were notably icteric. His cardiac The plasma exchange proceeded to antimicrobial treatment, but was still lame
auscultation was normal and did not identify uneventfully, and Buddy showed signs on the day of discharge. For that, he was
a murmur or arrhythmia. His heart rate was of improvement over the following days. prescribed paracetamol and physiotherapy
140bpm and his pulses were synchronous He was transitioned to oral prednisolone at home, in addition to additional analgesia
but bounding. and azathioprine was added as a second if required.
His thoracic auscultation was immunosuppressive agent during his period Buddy's PCV at the time of discharge
unremarkable, and his respiratory rate was of treatment at the RVC. was 31%. The referring vets reviewed
36 per minute. He was soft and comfortable On the 18th of January Buddy developed him 10 days later. Buddy’s PCV remained
on abdominal palpation. His peripheral marked hypoxaemia and dyspnoea that static post-discharge and a decision was
lymph nodes were normal on palpation. progressed to severe respiratory distress made to start weaning his steroids slightly
Buddy remained under the primary care the following day. Investigations and clinical with a close watch on his blood work. He
of the Critical Care Service due to his high suspicion were consistent with pulmonary unfortunately is still lame and a review
dependency for blood products and the thrombosis. consultation with our Orthopaedic Service
instability that caused. The Critical Care Fortunately, Buddy made a good has been recommended. Another option for
team discussed his case with the Internal improvement over the next few days, review of this ongoing lameness was for the
Medicine team daily to maintain a wholistic though there persisted an ongoing risk primary care vet to take radiographs of the
approach to his care. In addition to this, the of thromboembolic events due to his leg and the RVC team can help review them
Diagnostic Imaging team were pertinent hypercoagulable state secondary to the remotely.
If Buddy is clinically well and his PCV is
improving, we can consider tapering his
prednisolone dose at that stage by 25%. If
he continues to respond well to treatment,
his prednisolone dose can be tapered by
25% every two weeks as long as he is
clinically well and physical examination
and haematology, including blood smear
examination, does not raise concerns of
a relapse. Azathioprine will mostly likely
be continued for eight weeks after the
prednisolone has been stopped as long
as there are no side effect with its use.
We advised for serum biochemistry to be
performed every six to eight weeks as long
as Buddy is on azathioprine.
Get involved – we need cases to help
canine autoimmune research. This is one
of our projects, concerning IMHA and
biomarkers.

For small animal referrals, please call:
01707 666399
Email:
Buddy receiving a blood transfusion from the RVC team py qmhreception@rvc.ac.uk

6 Spring 2022