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Nunes NJS, Valle SDF, Okano FY, Almeida BA, Menin A, Costa FVA, Duda NCB, González FHD. Reference intervals for bone marrow cells in juvenile and young adult cats bone marrow cytology. Vet Clin Pathol 2024; 53:280-284. [PMID: 38684480 DOI: 10.1111/vcp.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/05/2024] [Accepted: 03/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The current bone marrow (BM) reference intervals (RI) are based on a limited number of cats. Age-related changes in BM variables might be important,possibly affecting the interpretation of the results. OBJECTIVES Establish BM cytologic reference intervals (RIs) and association of age and sex on these findings, in healthy juvenile and young adult cats. METHODS BM aspirates of cats deemed healthy based on history and clinical, CBC, serum chemistry findings, and negative retrovirus serology were obtained and examined cytologically. The examination included a 1000-nucleated differential cell count and cell morphologic assessment. RIs were calculated using parametric, robust, and nonparametric methods. The cytologic findings were examined for associations with sex and age. RESULTS The study included 40 cats (females, 22 [55%]; males, 18 [45%]) with a median age of 1.5 years (range 0.5-5). Most calculated RIs were similar to those previously reported. BM plasma cell and monocyte counts were weakly and positively correlated with age (rs, .312 and .373, respectively; P < .05). Metarubricytes were higher infemales (mean, 25.1%; SD, 6.0%) than males (mean, 21.2%; SD, 6.0%; P < .05). CONCLUSIONS The BM differential cell counts determined in this study can serve as RIs for cats aged 0.5-5 years.
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Affiliation(s)
- Nilson J S Nunes
- Veterinary Medicine College, Universidade Feevale, Novo Hamburgo, Brazil
| | - Stella de Faria Valle
- Department of Veterinary Clinical Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Y Okano
- Department of Veterinary Clinical Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruno A Almeida
- Department of Veterinary Clinical Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Angélica Menin
- Department of Veterinary Clinical Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda V A Costa
- Department of Animal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Naila C B Duda
- Veterinary Medicine College, Universidade de Passo Fundo, Passo Fundo, Brazil
| | - Félix H D González
- Department of Veterinary Clinical Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Maldonado‐Moreno A, Seth M, Monti P, Miller R. Clinical findings, treatment and outcome in cats diagnosed with precursor-targeted immune-mediated anaemia in a referral hospital in the UK: 30 cases (2010-2021). Vet Rec Open 2023; 10:e70. [PMID: 37645469 PMCID: PMC10460673 DOI: 10.1002/vro2.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023] Open
Abstract
Aims This retrospective study aimed to report clinical findings, treatment response and survival in cats diagnosed with precursor-targeted immune-mediated anaemia (PIMA) in a referral hospital in the UK. Methods Feline cases diagnosed with presumed PIMA between January 2010 and February 2021 were retrospectively recruited. Signalment, clinical signs, diagnostic tests, treatment and outcome were recorded. Descriptive analytics were performed. Outcomes were documented according to survival to discharge, 30-day survival, total survival time, response to immunosuppressive treatment and frequency of relapses. Results Thirty cats met the inclusion criteria. A higher prevalence of females (19/30) was identified (p = 0.001). Most cats (25/30) presented with haematocrit below 0.15 L/L. Concurrent cytopenias occurred in 18 of 30 cats. Bone marrow diagnosis was erythroid hyperplasia in 24 of 30 cases. Survival to discharge was documented in 26 of 30 cats, of which 23 survived more than 30 days since diagnosis. Initial treatment included blood products (26/30) and prednisolone (26/30) or prednisolone with ciclosporin (3/30); 18 of 30 cats responded to treatment, with a normal haematocrit at a mean of 28 days. The initial haematocrit and the presence of concurrent cytopenia were not statistically different between responders and non-responders. The median survival time was 140 days (range 1-3930 days). Conclusions and relevance The treatment response rate of feline PIMA was high (60%), with a mortality rate of 23% over the 30 days following diagnosis. Relapses occur frequently (77%) but the response rate after treatment modification was high (76%) and therefore ongoing treatment may be justified at that point. Long survival times (up to 3930 days) can be achieved.
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Affiliation(s)
| | | | | | - Rachel Miller
- CVS ReferralsVet Oracle TelemedicineCambridgeCambridgeshireUK
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3
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Warwick H, Harris B, Venier F, Rosa C. Non‐regenerative immune‐mediated anaemia managed following splenectomy and ovarian remnant removal. VETERINARY RECORD CASE REPORTS 2023. [DOI: 10.1002/vrc2.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
| | - Benjamin Harris
- Northwest Veterinary Specialists Runcorn UK
- Wear Veterinary Referrals Stockton‐on‐Tees UK
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4
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Sugawara-Suda M, Morishita K, Ichii O, Namba T, Aoshima K, Kagawa Y, Kim S, Hosoya K, Yokoyama N, Sasaki N, Nakamura K, Yamazaki J, Takiguchi M. Transcriptome and proteome analysis of dogs with precursor targeted immune-mediated anemia treated with splenectomy. PLoS One 2023; 18:e0285415. [PMID: 37146011 PMCID: PMC10162568 DOI: 10.1371/journal.pone.0285415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/23/2023] [Indexed: 05/07/2023] Open
Abstract
Precursor-targeted immune-mediated anemia (PIMA) in dogs is characterized by persistent non-regenerative anemia and ineffective erythropoiesis, and it is suspected to be an immune-mediated disease. Most affected dogs respond to immunosuppressive therapies; however, some are resistant. In this study, we carried out splenectomy as an alternative therapy for refractory PIMA in dogs, and analyzed gene expression levels in the spleen of dogs with or without PIMA and in serum before and after splenectomy. A total of 1,385 genes were found to express differentially in the spleens from dogs with PIMA compared with healthy dogs by transcriptome analysis, of which 707 genes were up-regulated, including S100A12, S100A8, and S100A9 that are linked directly to the innate immune system and have been characterized as endogenous damage-associated molecular patterns. Furthermore, immunohistochemistry confirmed that S100A8/A9 protein expression levels were significantly higher in dogs with PIMA compared with those in healthy dogs. A total of 22 proteins were found to express differentially between the serum samples collected before and after splenectomy by proteome analysis, of which 12 proteins were up-regulated in the samples before. The lectin pathway of complement activation was identified by pathway analysis in pre-splenectomy samples. We speculated that S100A8/9 expression may be increased in the spleen of dogs with PIMA, resulting in activation of the lectin pathway before splenectomy. These findings further our understanding of the pathology and mechanisms of splenectomy for PIMA.
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Affiliation(s)
- Mei Sugawara-Suda
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Keitaro Morishita
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Osamu Ichii
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Takashi Namba
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Keisuke Aoshima
- Laboratory of Comparative Pathology, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | | | - Sangho Kim
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Kenji Hosoya
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Nozomu Yokoyama
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Noboru Sasaki
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Kensuke Nakamura
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Jumpei Yamazaki
- Translational Research Unit, Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
- One Health Research Center, Hokkaido University, Hokkaido, Japan
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
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Nivy R, Sutton G, Bruchim Y. Carboxyhemoglobin as a diagnostic and prognostic biomarker of hemolytic anemias in dogs. J Vet Intern Med 2022; 37:110-116. [PMID: 36571460 PMCID: PMC9889617 DOI: 10.1111/jvim.16617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Endogenous production of carbon monoxide during hemoglobin metabolism leads to the formation of carboxyhemoglobin. Carboxyhemoglobin concentration is abnormally high in humans with hemolytic anemia (HA). HYPOTHESIS Measurement of carboxyhemoglobin concentration can discriminate HA from other forms of anemia. ANIMALS Twenty-seven dogs with HA (immune-mediated HA, n = 22; microangiopathic HA, n = 5), 27 dogs with non-HA (kidney disease, n = 14; immune-mediated thrombocytopenia, [n = 6]; miscellaneous, n = 7) and 24 nonanemic control dogs. METHODS Prospective cohort study. Carboxyhemoglobin quantification, a CBC and biochemistry profile were performed upon admission, and survival to hospital discharge and at 30 days were the measured outcomes. Groups were compared by the Mann-Whitney and Kruskal-Wallis tests. Receiver-operator characteristic (ROC) analyses were used to examine the predictive utility of carboxyhemoglobin for the diagnosis of HA in anemic dogs. RESULTS Carboxyhemoglobin (median [interquartile range]) differed between dogs with HA (7.7% [2.5%]) and non-HA (3.6% [1.05]; P < .001) and dogs with HA and nonanemic dogs (3.5% [0.65%]; P < .001). No difference was detected between nonHA and nonanemic dogs. The area under the ROC curve for carboxyhemoglobin as predictor of HA in anemic dogs was 0.997 (95% CI, 0.99-1.00). Three optimal cut-off points were identified, including 5.05%, 4.55% and 4.85%, with corresponding sensitivity/specificity of 92.6%/100%, 100%/92.6% and 96.3%/96.3%, respectively. Neither carboxyhemoglobin nor any of the CBC or chemistry analytes were associated with survival. CONCLUSIONS AND CLINICAL IMPORTANCE Carboxyhemoglobin proved an excellent predictor of HA in dogs and might constitute a useful, ancillary tool for diagnosing and monitoring hemolytic anemias.
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Affiliation(s)
- Ran Nivy
- Ben‐Shemen Specialist Referral CenterBen‐Shemen Youth VillageIsrael,Koret School of Veterinary MedicineThe Hebrew University of JerusalemRehovotIsrael
| | - Gila Sutton
- Koret School of Veterinary MedicineThe Hebrew University of JerusalemRehovotIsrael
| | - Yaron Bruchim
- Ben‐Shemen Specialist Referral CenterBen‐Shemen Youth VillageIsrael
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6
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Mizuno T, Inoue M, Kubo T, Iwaki Y, Kawamoto K, Itamoto K, Kambayashi S, Igase M, Baba K, Okuda M. Improvement of anemia in five dogs with nonregenerative anemia treated with allogeneic adipose-derived stem cells. Vet Anim Sci 2022; 17:100264. [PMID: 35898238 PMCID: PMC9310121 DOI: 10.1016/j.vas.2022.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 10/31/2022] Open
Abstract
Five canine cases with nonregenerative anemia were included in this study. All were treated with allogeneic adipose-derived stem cells (ADSCs). All cases showed improvement of anemia by ADSCs treatment.
Background Objectives Methods Results Conclusions
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7
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deLaforcade A, Bacek L, Blais M, Boyd C, Brainard BM, Chan DL, Cortellini S, Goggs R, Hoareau GL, Koenigshof A, Li R, Lynch A, Ralph A, Rozanski E, Sharp CR. 2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1- Defining populations at risk. J Vet Emerg Crit Care (San Antonio) 2022; 32:289-314. [PMID: 35499966 PMCID: PMC9322658 DOI: 10.1111/vec.13204] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations. DESIGN A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune-mediated hemolytic anemia (cats), protein-losing nephropathy (cats), protein-losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats). RESULTS Of the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein-losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune-mediated hemolytic anemia, protein-losing nephropathy, sepsis, or hyperadrenocorticism. CONCLUSIONS Associations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.
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Affiliation(s)
- Armelle deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Lenore Bacek
- Bluepearl Specialty and Emergency Pet HospitalTampaFloridaUSA
| | - Marie‐Claude Blais
- Department of Clinical SciencesUniversity of MontrealSaint‐HyacintheQCCanada
| | - Corrin Boyd
- School of Veterinary MedicineMurdoch UniversityMurdochAustralia
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, Clinical SciencesUniversity of GeorgiaAthensGeorgiaUSA
| | - Daniel L. Chan
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeLondonUK
| | - Stefano Cortellini
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeLondonUK
| | - Robert Goggs
- Department of Clinical SciencesCornell University College of Veterinary MedicineIthacaNew YorkUSA
| | | | - Amy Koenigshof
- Department of Emergency CareTwo by Two Animal HospitalBerrien SpringsMichiganUSA
| | - Ron Li
- Department of Veterinary Surgical and Radiological SciencesSchool of Veterinary MedicineUniversity of California DavisDavisCaliforniaUSA
| | - Alex Lynch
- Department of Clinical SciencesNC State College of Veterinary MedicineRaleighNorth CarolinaUSA
| | | | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Claire R Sharp
- School of Veterinary MedicineMurdoch UniversityMurdochAustralia
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8
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Lucidi CA, Gerlach JA, Jutkowitz A, Scott MA. Immunoglobulin G and phosphatidylserine in regenerative and nonregenerative immune-mediated anemias of dogs. J Vet Intern Med 2021; 35:2713-2721. [PMID: 34716708 PMCID: PMC8692184 DOI: 10.1111/jvim.16278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/08/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although precursor-targeted immune-mediated anemia (PIMA) is thought to be caused by immune targeting of erythroid precursors (nucleated RBCs, nRBCs), its pathogenesis is unknown. Immunoglobulin G (IgG) or phosphatidylserine (PS) may promote nRBC destruction in PIMA. HYPOTHESIS Dogs with PIMA have increased nRBC IgG and PS, and dogs with immune-mediated hemolytic anemia (IMHA) have increased RBC PS compared to healthy dogs. ANIMALS Blood from 20 healthy dogs and from dogs with IMHA (11) or other (non-IMHA) conditions (9), and marrow aspirates with or without blood from 10 healthy dogs and from dogs with PIMA (17) or other (non-IMHA, non-PIMA) conditions (7). METHODS Marrow nRBC stages were separated by density gradient. Flow cytometry was used to assess the percentage of RBCs or nRBCs with increased IgG or PS. RESULTS Red blood cell (RBC) IgG positivity was increased in 9/11 IMHA dogs and 0/9 non-IMHA dogs. Red blood cell PS positivity was increased in 10/11 IMHA dogs and 2/9 non-IMHA dogs. Five of 17 PIMA dogs had increased nRBC IgG positivity in mid- or late-stage fractions, whereas all 7 non-PIMA dogs were negative. Mid- and late-stage erythroid precursor PS was significantly higher in PIMA dogs compared to healthy dogs. Five of 14 PIMA dogs had increased RBC IgG positivity. CONCLUSIONS Immunoglobulin G and PS may promote destruction of nRBCs in PIMA dogs; PS may promote destruction of RBCs in IMHA dogs.
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Affiliation(s)
- Cynthia A Lucidi
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - John A Gerlach
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Ari Jutkowitz
- Department of Small Animal Clinical Science, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Michael A Scott
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
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Idalan N, Zeitz JO, Weber CN, Müller E, Giger U. Comparative study of immunohematological tests with canine blood samples submitted for a direct antiglobulin (Coombs') test. Canine Med Genet 2021; 8:10. [PMID: 34645506 PMCID: PMC8515749 DOI: 10.1186/s40575-021-00107-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A 2019 ACVIM consensus statement on diagnostics for immune-mediated hemolytic anemia (IMHA) in dogs made testing recommendations. As data on the performance of immunohematological tests was lacking, we undertook a comparative analysis. MATERIAL AND METHODS Anticoagulated blood samples from 126 dogs suspected of having IMHA submitted to a diagnostic veterinary laboratory for a routine direct antiglobulin test (DAT) and from 28 healthy control dogs were evaluated for spherocytosis and autoagglutination before and after three saline washes. Samples were also subjected to different DATs: a gel minitube and an immunochromatographic strip kit used in clinics; neutral gel column cards, microtiter plates (at 4°, 22°, and 37°C), capillary tubes, and flow cytometry used in laboratories. RESULTS Samples from healthy dogs yielded negative results with all immunodiagnostic tests. Among the 126 samples submitted for DAT 67 were positive by a DAT utilizing microtiter plates with goat anti-dog antiglobulin DAT at 22°C. Notably, DAT results were comparable and consistent across all evaluated methods regardless of antiglobulin and temperature used. DAT+ dogs were more severely anemic and more likely to have erythroid regeneration compared to DAT- dogs. Macroscopic agglutination in tubes or on slides was observed in 48 samples after 1:1 and 1:4 blood to saline dilution, but only persisted in four samples after washing. Among the DAT+ samples, 57% had agglutination, 87% had spherocytosis, and 45% had both. There was good correlation between spherocytosis and DAT results from the six DAT techniques, but the correlation with autoagglutination was only fair. Clinical follow-up was available for 42 dogs. Of the sample from 12 DAT+ dogs collected during treatment, 10 remained DAT+ when tested 1-24 weeks after initial assessment. CONCLUSIONS Based upon this comparative prospective survey, all in-clinic and laboratory DAT techniques produced similar results when performed by trained personnel and can therefore be recommended for detection of antibody-coated erythrocytes and immunohematological diagnosis. In addition, use of these tests for monitoring response of IMHA dogs to treatment might be valuable.
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Affiliation(s)
- Nadine Idalan
- Vetsuisse Faculty, University of Zürich, Winterthurerstrasse 260, 8057, Zürich, Switzerland
- Laboklin GmbH&Co.KG, Steubenstrasse 4, 97688, Bad Kissingen, Germany
| | - Johanna O Zeitz
- Laboklin GmbH&Co.KG, Steubenstrasse 4, 97688, Bad Kissingen, Germany
| | - Corinna N Weber
- Laboklin GmbH&Co.KG, Steubenstrasse 4, 97688, Bad Kissingen, Germany
| | - Elisabeth Müller
- Laboklin GmbH&Co.KG, Steubenstrasse 4, 97688, Bad Kissingen, Germany
| | - Urs Giger
- Vetsuisse Faculty, University of Zürich, Winterthurerstrasse 260, 8057, Zürich, Switzerland.
- Section of Medical Genetics, University of Pennsylvania, 3900 Delancey St, Philadelphia, PA, 19104, USA.
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10
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Akiyoshi M, Hisasue M, Neo S, Akiyoshi M. Precursor-targeted immune-mediated anemia in a dog with a stage IV mast cell tumor and bone marrow infiltration. Vet Clin Pathol 2021; 50:151-157. [PMID: 33655582 DOI: 10.1111/vcp.12982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
Abstract
A 12-year-old spayed female Shiba Inu dog was referred to our hospital for a suspected mast cell tumor (MCT) of the bone marrow (BM). Laboratory abnormalities included severe nonregenerative anemia (packed cell volume or PCV: 12.5%; reference interval (RI): 37.3-61.7%; reticulocytes: 35.1 × 103 /µL; RI: 10-110 × 103 /µL), and a few mast cells were visualized in the blood smear examination. The BM was hypercellular with hematopoietic cells, a decreased myeloid:erythroid (M:E) ratio (0.77; RI, 0.9-1.8), and no dysplastic hematopoietic cells. Mast cells accounted for 11.5% of the total nucleated BM cells. Neoplastic mast cells and histiocytes phagocytizing erythroid progenitor cells were occasionally noted. The dog was diagnosed with precursor-targeted immune-mediated anemia (PIMA) concurrent and a stage IV MCT infiltrating the BM. Multimodal treatment included toceranib, imatinib, vinblastine, lomustine (CCNU), prednisolone, cyclosporine, mycophenolate mofetil, and a blood transfusion. The dog died due to MCT progression lasting 139 days after the initial BM examination. To the best of our knowledge, this is the first report of a dog presenting with PIMA and a stage IV MCT infiltrating the BM.
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Affiliation(s)
- Makoto Akiyoshi
- Laboratory of Small Animal Internal Medicine, School of Veterinary Medicine, Azabu University, Sagamihara City, Japan.,Akiyoshi Animal Clinic, Yamato City, Japan
| | - Masaharu Hisasue
- Laboratory of Small Animal Internal Medicine, School of Veterinary Medicine, Azabu University, Sagamihara City, Japan
| | - Sakurako Neo
- Laboratory of Small Animal Internal Medicine, School of Veterinary Medicine, Azabu University, Sagamihara City, Japan
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Woolhead VL, Szladovits B, Chan A, Swann JW, Glanemann B. Breed predispositions, clinical findings, and prognostic factors for death in dogs with nonregenerative immune-mediated anemia. J Vet Intern Med 2021; 35:252-260. [PMID: 33617109 PMCID: PMC7848385 DOI: 10.1111/jvim.15986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Breed predispositions, survival, and prognostic factors have not been evaluated in dogs with nonregenerative immune-mediated anemia (nrIMA). HYPOTHESIS/OBJECTIVES To describe clinicopathologic variables, evaluate their associations with survival, and determine breed predispositions for dogs with nrIMA. ANIMALS Fifty-nine client-owned dogs with nrIMA. METHODS Referral hospital records were reviewed retrospectively for dogs with primary nrIMA (PCV ≤30%, corrected reticulocyte percentage (CR%) ≤1.0, bone marrow sampling with evidence of immune-mediated destruction, and underlying causes excluded). Breed predispositions were evaluated by calculation of odds ratios in a case control study; prognostic factors by logistic regression in a cohort study. RESULTS Fifty-nine dogs with nrIMA had a median PCV of 12% (interquartile range [IQR]: 10%-17%) and CR% 0.1 (0%-0.2%). At least ≥1 ACVIM IMHA diagnostic criteria were met by 35 dogs (59%). Whippets, Lurchers, and miniature Dachshunds were predisposed to nrIMA. Median survival time was 277 days (IQR: 37-1925), with 3- and 12-month survival rates 61% and 43%, respectively. Erythroid regeneration and remission were achieved by 88% and 62% of dogs, respectively. Corrected reticulocyte percentage >0.2 was associated with improved survival. CONCLUSION AND CLINICAL IMPORTANCE Although there is overlap of clinical features between dogs with IMHA and nrIMA, the prognosis for those with nrIMA depends predominantly on the severity of reticulocytopenia.
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Affiliation(s)
- Vanessa L. Woolhead
- Eastcott ReferralsSwindonUK
- Department of Clinical Science and ServicesRoyal Veterinary CollegeLondonUK
| | - Balazs Szladovits
- Department of Pathobiology and Population SciencesRoyal Veterinary CollegeLondonUK
| | | | - James W. Swann
- Department of Clinical Science and ServicesRoyal Veterinary CollegeLondonUK
- Kennedy Institute of Rheumatology, University of OxfordOxfordUK
| | - Barbara Glanemann
- Department of Clinical Science and ServicesRoyal Veterinary CollegeLondonUK
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12
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Akiyoshi M, Hisasue M, Neo S, Akiyoshi M. Presumptive precursor-targeted immune-mediated anemia concurrent with gastrointestinal lymphoma in a cat. J Vet Med Sci 2020; 82:1570-1576. [PMID: 32863286 PMCID: PMC7719880 DOI: 10.1292/jvms.20-0386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 10-year-old spayed female mixed-breed cat presented with progressive nonregenerative anemia. Clinicopathological abnormalities included severe
nonregenerative anemia (packed cell volume [PCV]: 7%, aggregate reticulocytes: 1.12 × 103/µl) and a hypoechogenic mass
well-localized in the stomach. Bone marrow (BM) smears revealed increased particle hematopoietic cellularity with decreased myeloid:erythroid (M:E) ratios, no
dysplasia of any lineage, and presence of erythroid precursors phagocytized by macrophages. The cat was diagnosed with presumptive precursor-targeted
immune-mediated anemia (PIMA). The stomach mass was consistent with CD 20 positive T-cell lymphoma. The lymphoma was completely resected via surgery, and the
PIMA was cured by immunosuppressive therapy. On day 410, both diseases have not recurred without medications. This is the first report of feline PIMA and
concurrent gastrointestinal lymphoma.
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Affiliation(s)
- Makoto Akiyoshi
- Laboratory of Small Animal Internal Medicine, Azabu University, Sagamihara-shi, 1-17-71 Fuchinobe, Chuuku, Sagamihara-shi, Kanagawa 252-5201, Japan.,Akiyoshi Animal Clinic, 5-4-26 Chuorinkannishi, Yamato-shi, Kanagawa 242-0008, Japan
| | - Masaharu Hisasue
- Laboratory of Small Animal Internal Medicine, Azabu University, Sagamihara-shi, 1-17-71 Fuchinobe, Chuuku, Sagamihara-shi, Kanagawa 252-5201, Japan
| | - Sakurako Neo
- Laboratory of Clinical Diagnosis, Azabu University, 1-17-71 Fuchinobe, Chuoku, Sagamihara-shi, Kanagawa 252-5201, Japan
| | - Masami Akiyoshi
- Akiyoshi Animal Clinic, 5-4-26 Chuorinkannishi, Yamato-shi, Kanagawa 242-0008, Japan
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Assenmacher TD, Jutkowitz LA, Koenigshof AM, de A Lucidi C, Scott MA. Clinical features of precursor-targeted immune-mediated anemia in dogs: 66 cases (2004-2013). J Am Vet Med Assoc 2020; 255:366-376. [PMID: 31298643 DOI: 10.2460/javma.255.3.366] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize the clinical features of dogs with precursor-targeted immune-mediated anemia (PIMA). ANIMALS 66 dogs with PIMA. PROCEDURES Electronic record databases of a teaching hospital were searched to identify dogs with a diagnosis of nonregenerative anemia between 2004 and 2013. Inclusion criteria included persistent nonregenerative anemia (Hct ≤ 30% and reticulocyte count < 76,000 reticulocytes/μL), cytologic findings supportive of ineffective bone marrow erythropoiesis, and absence of underlying disease. Information regarding clinical signs, clinicopathologic findings, treatment, and outcome was extracted from records of eligible dogs. A regenerative response was defined as a reticulocyte count > 76,000 reticulocytes/μL or sustained increase in Hct of > 5%. Remission was defined as a stable Hct ≥ 35%. RESULTS The median Hct was 13%, and reticulocyte count was 17,900 reticulocytes/μL. Rubriphagocytosis was identified in bone marrow aspirate samples from 61 of 66 dogs. Collagen myelofibrosis was detected in bone marrow biopsy specimens obtained from 31 of 63 dogs. Immune-mediated targeting of mature erythrocytes was uncommon. All dogs received immunosuppressive therapy. Fifty-five dogs developed a regenerative response at a median of 29 days, and 40 of those dogs went into remission at a median of 59 days after PIMA diagnosis. Thromboembolic events were confirmed for 9 dogs and were associated with a decreased survival time. Median survival time was 913 days for all dogs. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that most dogs with PIMA responded to prolonged immunosuppressive therapy. Studies to determine optimal immunosuppressive and thromboprophylactic protocols for dogs with PIMA are warranted.
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Rout ED, Labadie JD, Curran KM, Yoshimoto JA, Avery AC, Avery PR. Immunophenotypic characterization and clinical outcome in cats with lymphocytosis. J Vet Intern Med 2019; 34:105-116. [PMID: 31693230 PMCID: PMC6979106 DOI: 10.1111/jvim.15650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/08/2019] [Indexed: 11/29/2022] Open
Abstract
Background Lymphocytosis is relatively common in cats, but few studies describe lymphocyte populations or the clinical course associated with different immunophenotypic expansions. Hypothesis/Objectives We hypothesized that cats frequently develop non‐neoplastic lymphocytosis and that different neoplastic immunophenotypes have variable prognoses. We aimed to characterize the lymphocyte expansions in a large population of cats with lymphocytosis and to assess clinical presentation and outcome in a subset. Animals Three cohorts of cats older than 1 year with lymphocytosis (>6000/μL) were examined to define immunophenotypic categories (n = 146), evaluate outcome (n = 94), and determine prevalence of immunophenotypes (n = 350). Methods Retrospective study of cats with blood submitted for flow cytometry. Medical records (n = 94) were reviewed for clinical data, treatment, and survival information. Results Five major immunophenotypic categories were identified: B cell, heterogeneous (≥2 lineages expanded), CD4+ T cell, CD4−CD8− (double negative [DN]) T cell, and CD5‐low‐expressing T cell. B‐cell and heterogeneous phenotypes were more consistent with a non‐neoplastic process, having polyclonal antigen receptor gene rearrangements, younger age at presentation, lower lymphocyte counts, and prolonged survival. The neoplastic phenotypes, CD4+ T cell, DN T cell, and CD5 low T cell, had different median survival times (752 days [n = 37], 271 days [n = 7], 27.5 days [n = 12], respectively). Among CD4+ T‐cell cases, cats with abdominal lymphadenopathy, intestinal involvement, or both and females had shorter survival. Among 350 cats with lymphocytosis, CD4+ T‐cell lymphocytosis was most common, followed by heterogeneous and B‐cell phenotypes. Conclusions and Clinical Importance Neoplastic CD4+ T‐cell lymphocytosis is common in cats and has a prolonged clinical course compared to aberrant T‐cell phenotypes. Cats with heterogeneous and B‐cell lymphocyte expansions commonly have non‐neoplastic disease.
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Affiliation(s)
- Emily D Rout
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Julia D Labadie
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Kaitlin M Curran
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon
| | - Janna A Yoshimoto
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Anne C Avery
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Paul R Avery
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
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15
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MacNeill AL, Dandrieux J, Lubas G, Seelig D, Szladovits B. The utility of diagnostic tests for immune-mediated hemolytic anemia. Vet Clin Pathol 2019; 48 Suppl 1:7-16. [PMID: 31502273 DOI: 10.1111/vcp.12771] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/13/2019] [Accepted: 06/02/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND A definitive diagnosis of immune-mediated hemolytic anemia (IMHA) can be difficult to make. However, it is critical to differentiate IMHA from other causes of anemia due to the impact on prognosis and outcome for IMHA patients. Recently published American College of Veterinary Internal Medicine recommendations for the diagnosis of IMHA should be followed to concurrently confirm ongoing anemia, verify in vivo hemolysis, and detect anti-erythrocyte antibodies. The reliability of immunologic IMHA tests varies depending on which test is used and how it is performed. OBJECTIVES Our aims were to determine which tests are currently used in veterinary medicine to diagnose IMHA and review the utility of assays that have historically been used to diagnose IMHA. METHODS A short survey was designed to see which diagnostic tests for IMHA were currently being used by veterinary practices. The survey was distributed via list-serves to veterinarians and veterinary technologists. A literature review was performed to report the utility of diagnostic tests for the diagnosis of IMHA. RESULTS Survey respondents indicated a variability in test protocols used to diagnose IMHA. Most respondents perform saline agglutination or Coombs' tests to detect anti-erythrocyte antibodies. Additional tests that can be used to support a diagnosis of IMHA are discussed in this review. CONCLUSIONS A standardized diagnostic approach should be followed to differentiate IMHA from other causes of anemia. Test methodology can vary from one laboratory to another, and clinicians should be familiar with the procedures used by their laboratory.
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Affiliation(s)
| | - Amy L MacNeill
- Department of Microbiology, Immunology, and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Julien Dandrieux
- Faculty of Veterinary and Agricultural Sciences, Translational Research and Animal Clinical Trial Study (TRACTS) Group, The University of Melbourne, Werribee, Vic., Australia
| | - George Lubas
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Davis Seelig
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | - Balázs Szladovits
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, University of London, Hertfordshire, UK
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16
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Winzelberg Olson S, Hohenhaus AE. Feline non-regenerative anemia: Diagnostic and treatment recommendations. J Feline Med Surg 2019; 21:615-631. [PMID: 31234748 PMCID: PMC10814193 DOI: 10.1177/1098612x19856178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PRACTICAL RELEVANCE Non-regenerative anemia, or anemia with reticulocytopenia, is a daily diagnosis in feline practice. CLINICAL CHALLENGES The disease processes underlying non-regenerative anemia are many and diverse. A major diagnostic evaluation may be required to correctly diagnose and treat the underlying cause. AUDIENCE All veterinarians caring for cats will face the diagnostic and therapeutic challenge of non-regenerative anemia. Readers will benefit from the review of diagnostic testing and therapeutic options for non-regenerative anemia. EVIDENCE BASE This review summarizes the currently available literature informing diagnostic and treatment recommendations related to non-regenerative anemia. The evidence available to support the recommendations in this review is graded as low and includes predominantly expert opinion, case reports and cases series, on which the authors' interpretation/consensus is based.
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Affiliation(s)
- Sarah Winzelberg Olson
- DVM, Diplomate ACVIM (Oncology and Small Animal Internal Medicine) Animal Medical Center, New York, NY, USA
| | - Ann E Hohenhaus
- DVM, Diplomate ACVIM (Oncology and Small Animal Internal Medicine) Animal Medical Center, New York, NY, USA
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17
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Garden OA, Kidd L, Mexas AM, Chang YM, Jeffery U, Blois SL, Fogle JE, MacNeill AL, Lubas G, Birkenheuer A, Buoncompagni S, Dandrieux JRS, Di Loria A, Fellman CL, Glanemann B, Goggs R, Granick JL, LeVine DN, Sharp CR, Smith-Carr S, Swann JW, Szladovits B. ACVIM consensus statement on the diagnosis of immune-mediated hemolytic anemia in dogs and cats. J Vet Intern Med 2019; 33:313-334. [PMID: 30806491 PMCID: PMC6430921 DOI: 10.1111/jvim.15441] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/18/2019] [Indexed: 12/21/2022] Open
Abstract
Immune-mediated hemolytic anemia (IMHA) is an important cause of morbidity and mortality in dogs. IMHA also occurs in cats, although less commonly. IMHA is considered secondary when it can be attributed to an underlying disease, and as primary (idiopathic) if no cause is found. Eliminating diseases that cause IMHA may attenuate or stop immune-mediated erythrocyte destruction, and adverse consequences of long-term immunosuppressive treatment can be avoided. Infections, cancer, drugs, vaccines, and inflammatory processes may be underlying causes of IMHA. Evidence for these comorbidities has not been systematically evaluated, rendering evidence-based decisions difficult. We identified and extracted data from studies published in the veterinary literature and developed a novel tool for evaluation of evidence quality, using it to assess study design, diagnostic criteria for IMHA, comorbidities, and causality. Succinct evidence summary statements were written, along with screening recommendations. Statements were refined by conducting 3 iterations of Delphi review with panel and task force members. Commentary was solicited from several professional bodies to maximize clinical applicability before the recommendations were submitted. The resulting document is intended to provide clinical guidelines for diagnosis of, and underlying disease screening for, IMHA in dogs and cats. These should be implemented with consideration of animal, owner, and geographical factors.
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Affiliation(s)
- Oliver A Garden
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Linda Kidd
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California
| | - Angela M Mexas
- College of Veterinary Medicine, Midwestern University, Downers Grove, Illinois
| | - Yu-Mei Chang
- Royal Veterinary College, University of London, London, United Kingdom
| | - Unity Jeffery
- College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Shauna L Blois
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Jonathan E Fogle
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Amy L MacNeill
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - George Lubas
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Adam Birkenheuer
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Simona Buoncompagni
- Internal Medicine Service, Central Oklahoma Veterinary Specialists, Oklahoma City, Oklahoma
| | - Julien R S Dandrieux
- Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, University of Melbourne, Melbourne, Australia
| | - Antonio Di Loria
- Department of Veterinary Medicine and Animal Production, University of Napoli Federico II, Napoli, Italy
| | - Claire L Fellman
- Cummings School of Veterinary Medicine, Tufts University, Massachusetts
| | - Barbara Glanemann
- Royal Veterinary College, University of London, London, United Kingdom
| | - Robert Goggs
- College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Jennifer L Granick
- College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota
| | - Dana N LeVine
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Claire R Sharp
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | | | - James W Swann
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Balazs Szladovits
- Royal Veterinary College, University of London, London, United Kingdom
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Almeida T, Sousa Filho R, Rodrigues I, Cruz R, Rodrigues A, Silva I. Linfoma leucemizado em felino coinfectado com os vírus da imunodeficiência felina e da leucemia felina: relato de caso. ARQ BRAS MED VET ZOO 2019. [DOI: 10.1590/1678-4162-10382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO O presente trabalho teve por objetivo relatar um caso de linfoma leucemizado em um felino coinfectado com os vírus da imunodeficiência felina (FIV) e o da leucemia felina (FeLV). Foram realizados exames de hemograma, contagem de reticulócitos, mielograma, bioquímica, teste de imunocromatografia para FIV e FeLV, imunofluorescência indireta (IFA) para FeLV, radiografia torácica e citologia renal. Esse último exame revelou um linfoma extranodal. Foi determinante para a conclusão diagnóstica a associação dos sinais clínicos corroborados com a infiltração de elevada quantidade de células linfoblásticas na medula óssea, exibindo critérios citomorfológicos de malignidade, como mitoses atípicas, relacionadas à presença de corpúsculos linfoglandulares e material hematopoiético inter-relacionado. O linfoma é uma neoplasia relativamente comum em felinos, entretanto, a apresentação leucemizada é rara, podendo representar um desafio diagnóstico clínico, o que torna fundamental a inclusão da citologia medular na prática clínica dessa espécie.
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Affiliation(s)
- T.M. Almeida
- Universidade Federal Rural de Pernambuco, Brazil
| | | | | | - R.O. Cruz
- Universidade Estadual do Ceará, Brazil
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Turinelli V, Gavazza A. Retrospective study of 152 feline cytological bone marrow examinations: preliminary classification and ranges. J Feline Med Surg 2018; 20:1158-1168. [PMID: 29451443 PMCID: PMC11104214 DOI: 10.1177/1098612x18757602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Cytological assessment of the bone marrow is an essential tool for understanding and investigating haematological abnormalities. Sometimes it represents the only way to reach a definitive diagnosis. The purpose of this study was to provide a general overview regarding the prevalence of feline bone marrow disorders encountered in a private European laboratory setting, to classify them and to assess the differential cell counts related to such disorders. METHODS In total, 152 bone marrow samples were classified using cytological and numerical criteria. The bone marrow cytological examinations were performed after the identification of haematological alterations, such as cytopenias, increased number of cells or suspicion of malignant blood disorders. RESULTS Of the 152 bone marrow samples evaluated, 71 (46.7%) were classified as hyperplastic, primarily granulocytic and erythroid hyperplasia (50.7% and 45.1%, respectively, of the total hyperplasia); 23 (15.1%) showed dysmyelopoiesis, mainly in the form of myelodysplastic syndrome (39.1% of the total dysmyelopoiesis); 21 (13.8%) had no cytological abnormalities; 17 (11.2%) were malignant blood disorders; 15 (9.9%) had hypoplastic conditions; and two (1.3%) were miscellaneous diseases. Metastatic disease was detected in only two cases (1.3%). Differential cell counts and myeloid-to-erythroid (M:E) ratios were reported for normal, erythroid hypoplastic, erythroid and granulocytic hyperplastic and dysplastic conditions. CONCLUSIONS AND RELEVANCE This study provides a general overview of the prevalence and incidence of feline bone marrow disorders together with ranges for differential nucleated cell counts and M:E ratios for the various conditions reported.
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Affiliation(s)
| | - Alessandra Gavazza
- Department of Veterinary Sciences, University of Pisa, Pisa 56122, Italy
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20
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Lucidi CA, Gerlach JA, Forney S, Jutkowitz LA, Scott MA. Analytic characterization of flow cytometric assays for detection of immunoglobulin G on canine erythroid cells, including detection of dog erythrocyte antigen 1 on erythroid precursors. Am J Vet Res 2018; 79:1123-1132. [PMID: 30372157 DOI: 10.2460/ajvr.79.11.1123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop and characterize flow cytometric assays for detecting IgG bound to canine erythrocytes and bone marrow erythroid precursors. SAMPLE Blood samples from 20 healthy and 61 sick dogs with (n = 33) or without (28) immune-mediated hemolytic anemia (IMHA) and bone marrow samples from 14 healthy dogs. PROCEDURES A flow cytometric assay for measurement of IgG on RBCs was developed, and appropriate positive control cells were generated. Analytic and diagnostic performance were characterized. The RBC IgG assay was then combined with density-gradient fractionation of aspirated bone marrow cells and a 2-color process to yield an assay for detecting IgG on nucleated RBCs (nRBCs). Cell sorting and cytologic examination confirmed target cell populations, and anti-dog erythrocyte antigen 1 (DEA1) blood-typing serum was used to generate IgG-positive nRBCs. RESULTS Within- and between-run coefficients of variation for the RBC IgG assay were 0.1% to 13.9%, and > 90% of spiked IgG-positive RBCs were detected. Diagnostic sensitivity and specificity of the assay for detection of IMHA were 88% and 93%, respectively. Cytologic findings for sorted bone marrow fractions rich in early-, mid-, and late-stage nRBCs from 3 healthy dogs indicated 89% to 98% nRBC purity. After IgG coating with anti-DEA1 blood-typing serum, IgG was detected on nRBCs from DEA1-positive, but not DEA1-negative, healthy dogs. CONCLUSIONS AND CLINICAL RELEVANCE The developed RBC IgG assay had favorable analytic and diagnostic performance for detection of IMHA in dogs and was successfully adapted to detect IgG on canine nRBCs of various maturation stages. The findings supported the presence of DEA1 on canine nRBCs.
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21
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Randell MG, Balakrishnan N, Gunn-Christie R, Mackin A, Breitschwerdt EB. Bartonella henselae infection in a dog with recalcitrant ineffective erythropoiesis. Vet Clin Pathol 2018; 47:45-50. [PMID: 29393980 DOI: 10.1111/vcp.12575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Ineffective erythropoiesis was diagnosed in an 8-year-old male castrated Labrador Retriever. Despite treatment with immunosuppressive therapy for suspected immune-mediated erythrocyte maturation arrest, resolution of the nonregenerative anemia was not achieved. Following documentation of Bartonella henselae bacteremia by Bartonella alpha proteobacteria growth medium (BAPGM) enrichment blood culture, immunosuppressive therapy was discontinued, and the anemia resolved following prolonged antibiotic therapy. Bartonella immunofluorescent antibody testing was negative, whereas B henselae western blot was consistently positive. The contribution of B henselae bacteremia to ineffective erythropoiesis remains unknown; however, the potential role of B henselae in the pathophysiology of bone marrow dyscrasias warrants additional investigation.
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Affiliation(s)
| | - Nandhakumar Balakrishnan
- Department of Clinical Sciences, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,The Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | | | - Andrew Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - Edward B Breitschwerdt
- Department of Clinical Sciences, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,The Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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23
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Keresztes MA, Henrich M, Baloi P, Gerst S, Rudnick JC, Langenstein J, Moritz A, Bauer N. Nonregenerative immune-mediated anemia associated with a diffuse large B-cell lymphoma in a captive jaguar (Panthera onca
). Vet Clin Pathol 2017; 46:597-604. [DOI: 10.1111/vcp.12542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Monika A. Keresztes
- Clinical Pathophysiology and Clinical Pathology; Department of Veterinary Clinical Sciences; Justus-Liebig-University; Gießen Germany
| | - Manfred Henrich
- Institute of Veterinary Pathology; Justus-Liebig-University; Gießen Germany
| | - Penelope Baloi
- Small Animal Hospital and Animal Shelter; Tierklinik GmbH; Rostock Germany
| | - Sascha Gerst
- State Office for Agriculture; Food Safety and Fishery Mecklenburg-Vorpommern; Department for Diagnostic Investigation of Epizootics; Rostock Germany
| | | | - Judith Langenstein
- Clinical Pathophysiology and Clinical Pathology; Department of Veterinary Clinical Sciences; Justus-Liebig-University; Gießen Germany
| | - Andreas Moritz
- Clinical Pathophysiology and Clinical Pathology; Department of Veterinary Clinical Sciences; Justus-Liebig-University; Gießen Germany
| | - Natali Bauer
- Clinical Pathophysiology and Clinical Pathology; Department of Veterinary Clinical Sciences; Justus-Liebig-University; Gießen Germany
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de Marchi PN, Sueur Vieira ANL, Antunes Ribeiro JF, Geraldes SS, Rodrigues Ramos PR, Melchert A, Guimarães-Okamoto PTC. Use of Nandrolone Decanoate in Treatment of Pure Red Cell Aplasia Secondary to Diclofenac Administration: A Case Report. Top Companion Anim Med 2017; 32:44-47. [PMID: 28750791 DOI: 10.1053/j.tcam.2017.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/10/2017] [Indexed: 11/11/2022]
Abstract
Pure red cell aplasia (PRCA) is a disorder that leads to a nonregenerative anemia that results from erythroid precursors failing to reach maturity in the bone marrow, whereas the numbers of mature myeloid and megakaryocytic cells remain normal. PRCA can be induced by autoimmune processes, infections, drugs, toxins, and radiation, and is diagnosed by a bone marrow cytology examination after excluding the most common causes of nonregenerative anemia. Immunosuppressive therapies are used to treat PRCA, and usually involve the use of glucocorticoids, cyclosporin, or azathioprine. Alternatively, although little studied in veterinary medicine, drugs which stimulate bone marrow (e.g., nandrolone decanoate) have been mentioned as possible therapeutic agents. A case of PRCA that presented at the Veterinary Teaching Hospital of the Faculty of Veterinary Medicine and Animal Science (UNESP)-Botucatu, Brazil showed a good therapeutic response to weekly administration of nandrolone decanoate. Therefore, it was concluded that bone marrow stimulants might improve the quality of life of PRCA patients, provided they are used with caution and under close clinical supervision.
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Affiliation(s)
- Paula Nassar de Marchi
- Veterinary Clinic Department, School of Veterinary Medicine and Animal Science, São Paulo State University-UNESP, São Paulo, Brazil
| | - André Nanny Le Sueur Vieira
- Veterinary Clinic Department, School of Veterinary Medicine and Animal Science, São Paulo State University-UNESP, São Paulo, Brazil
| | - José Francisco Antunes Ribeiro
- Veterinary Clinic Department, School of Veterinary Medicine and Animal Science, São Paulo State University-UNESP, São Paulo, Brazil
| | - Silvano Salgueiro Geraldes
- Veterinary Clinic Department, School of Veterinary Medicine and Animal Science, São Paulo State University-UNESP, São Paulo, Brazil
| | | | - Alessandra Melchert
- Veterinary Clinic Department, School of Veterinary Medicine and Animal Science, São Paulo State University-UNESP, São Paulo, Brazil
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25
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Abstract
Practical relevance: Hematologic disorders are relatively common in cats, as inflammatory, immune-mediated and infectious diseases have the potential to impact erythroid, myeloid and thrombopoietic lines within the bone marrow. Clinical challenges: Clinicians often benefit from information obtained from bone marrow cytology and histopathology in diagnosing hematologic disorders in feline patients. However, these sampling procedures are ones that many veterinarians are intimidated by and thus not comfortably performing in clinical practice. AUDIENCE This review, aimed at all veterinarians who treat cats, highlights the reasons a clinician may elect to sample bone marrow, and details the collection of bone marrow for both cytology and histopathology. Potential complications and limitations of each procedure are also reviewed. Evidence base: The collection of bone marrow for cytology and histopathology is not new to feline medicine and several research studies have investigated various sampling modalities in cats. This article offers a comprehensive review of the currently accepted best practices.
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Affiliation(s)
- Christopher G Byers
- VCA MidWest Veterinary Referral & Emergency Center, 9706 Mockingbird Drive, Omaha, NE, 68127, USA
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26
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Lucidi CDA, de Rezende CLE, Jutkowitz LA, Scott MA. Histologic and cytologic bone marrow findings in dogs with suspected precursor-targeted immune-mediated anemia and associated phagocytosis of erythroid precursors. Vet Clin Pathol 2017; 46:401-415. [PMID: 28582594 DOI: 10.1111/vcp.12502] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Precursor-targeted immune-mediated anemia (PIMA) has been suspected in dogs with nonregenerative anemia and bone marrow findings varying from erythroid hyperplasia to pure red cell aplasia. Phagocytosis of erythroid precursors/rubriphagocytosis (RP) reported in some affected dogs suggests a destructive component to the pathogenesis of PIMA. OBJECTIVES The purpose of the study was to characterize laboratory and clinical findings in dogs with suspected PIMA and RP, with emphasis on cytologic and histologic bone marrow findings. METHODS Dogs with PIMA and RP were identified by review of paired bone marrow aspirate and core biopsy slides collected over a 4-year period. Samples were systematically assessed and characterized along with other pertinent laboratory data and clinical findings. RESULTS Twenty-five dogs met criteria for PIMA and had RP that was relatively stage-selective. Erythropoiesis was expanded to the stage of erythroid precursors undergoing most prominent phagocytosis, yielding patterns characterized by a hypo-, normo-, or hypercellular erythroid lineage. A 4th pattern involved severe collagen myelofibrosis, and there was a spectrum of mild to severe collagen myelofibrosis overall. Evidence of immune-mediated hemolysis was rare. Immunosuppressive therapy was associated with remission in 77% of dogs treated for at least the median response time of 2 months. CONCLUSIONS Bone marrow patterns in dogs fulfilling criteria for PIMA were aligned with stage-selective phagocytosis of erythroid precursors and the development of collagen myelofibrosis, common in dogs with PIMA. Recognition of these patterns and detection of RP facilitates diagnosis of PIMA, and slow response to immunosuppressive therapy warrants further investigation into its pathogenesis.
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Affiliation(s)
- Cynthia de A Lucidi
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Christian L E de Rezende
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - L Ari Jutkowitz
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Michael A Scott
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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Paltrinieri S, Rossi G, Manca M, Scarpa P, Vitiello T, Giordano A. Sensitivity and specificity of manual and automated measurements of reticulocyte parameters for classification of anemia in dogs: 174 cases (1993-2013). J Am Vet Med Assoc 2016; 249:776-86. [PMID: 27654164 DOI: 10.2460/javma.249.7.776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess sensitivity and specificity of manual and automated measurements of reticulocyte percentage, number, and production index for classification of anemia in dogs. DESIGN Retrospective case series SAMPLE 174 blood smears from client-owned dogs with anemia collected between 1993 and 2013 for which reticulocyte parameters were determined manually (nonregenerative anemia, 22; preregenerative anemia, 23; regenerative anemia, 28) or with an automated laser-based counter (nonregenerative anemia, 66; preregenerative anemia, 17; regenerative anemia, 18). PROCEDURES Diagnostic performance was evaluated with receiver operating characteristic (ROC) curves by considering preregenerative anemia as nonregenerative or regenerative. Sensitivity, specificity, and positive likelihood ratio were calculated by use of cutoffs determined from ROC curves or published reference limits. RESULTS Considering preregenerative anemia as non regenerative, areas under the curve (AUCs) for reticulocyte percentage, number, and production index were 97%, 93%, and 91% for manual counting and 93%, 90%, and 93% for automated counting. Sensitivity, specificity, and positive likelihood ratio were 82% to 86%, 82% to 87%, and 4.6 to 6.4, respectively. Considering preregenerative anemia as regenerative, AUCs were 77%, 82%, and 80% for manual counting and 81%, 82%, and 92% for automated counting. Sensitivity, specificity, and positive likelihood ratio were 72% to 74%, 76 to 87%, and 2.7 to 6.2, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Whereas all reticulocyte parameters identified regeneration in anemic dogs, the performance of specific parameters was dependent on the method used. Findings suggested that lower cutoffs than published reference limits are preferred for reticulocyte number and production index and higher cutoffs are preferred for reticulocyte percentage. Reticulocyte production index may be useful when the pretest probability of regeneration is moderate.
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Black V, Adamantos S, Barfield D, Tasker S. Feline non-regenerative immune-mediated anaemia: features and outcome in 15 cases. J Feline Med Surg 2016; 18:597-602. [PMID: 26116621 PMCID: PMC10816389 DOI: 10.1177/1098612x15588800] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
OBJECTIVES Pure red cell aplasia (PRCA) and non-regenerative immune-mediated haemolytic anaemia (NRIMHA) are uncommon causes of non-regenerative anaemia affecting the bone marrow in the cat. This retrospective study aimed to describe the clinical features, treatment and outcome (remission and survival) of cats with these disorders. METHODS Cases of PRCA and NRIMHA presenting between 2009 and 2013 were retrieved. Clinical features including signalment, history, clinical signs and diagnostic investigations were recorded, as well as treatment(s) used and outcome (remission and survival). Outcome was compared for PRCA and NRIMHA. RESULTS Fifteen cats met inclusion criteria: seven with PRCA and eight with NRIMHA. The majority (12/15) were younger than 3 years of age. Volume overload was common (8/11). Treatment with whole blood transfusions with or without Oxyglobin was necessary in most cats (14/15) and resulted in congestive heart failure in one cat. Most cats (11/15) achieved remission 12-42 days after starting immunosuppressive treatment. Treatment protocols associated with remission were glucocorticoids alone (remission in 6/7 cats), glucocorticoids and chlorambucil (remission in 3/6 treated cats), glucocorticoids and ciclosporin (one cat only) and ciclosporin alone (one cat only). Relapse was observed in 3/11 cats, and 8/11 cats were still receiving treatment at the time of follow-up. Outcome (remission and survival) did not differ between PRCA and NRIMHA. CONCLUSIONS AND RELEVANCE PRCA and NRIMHA are uncommon causes of anaemia in predominantly young cats. The prognosis is reasonable, with a mortality rate of 27%, and it can take at least 6 weeks before remission is observed. Following clinical remission, gradual withdrawal of immunosuppressive treatments should be attempted, with close monitoring for relapse; some cats may require long-term treatment. This study is the first to report the use of chlorambucil as an adjunctive immunosuppressant in these cases. Outcome did not differ for PRCA and NRIMHA.
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Affiliation(s)
- Victoria Black
- The Feline Centre, Langford Veterinary Services, University of Bristol, Langford, UK
| | - Sophie Adamantos
- The Feline Centre, Langford Veterinary Services, University of Bristol, Langford, UK
| | - Dominic Barfield
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, UK
| | - Séverine Tasker
- The Feline Centre, Langford Veterinary Services, University of Bristol, Langford, UK
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Swann JW, Skelly BJ. Canine autoimmune hemolytic anemia: management challenges. VETERINARY MEDICINE-RESEARCH AND REPORTS 2016; 7:101-112. [PMID: 30050843 PMCID: PMC6055891 DOI: 10.2147/vmrr.s81869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Immune-mediated hemolytic anemia is one of the most common manifestations of canine immune-mediated disease, yet treatment regimens remain nonstandardized and, in some cases, controversial. The main reason for this, as for most diseases in veterinary medicine, is the lack of large-scale placebo-controlled trials so that the efficacy of one treatment over another can be established. Most of the evidence used for treatment comes from retrospective studies and from personal preference and experience, and because of this, treatment regimens tend to vary among institutions and individual clinicians. Management of immune-mediated hemolytic anemia includes immunosuppression, thromboprophylaxis, and supportive care measures to help prevent and treat concurrent conditions.
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Affiliation(s)
- James W Swann
- Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, Hertfordshire
| | - Barbara J Skelly
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK,
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Southard TL, Rodriguez-Ramos Fernandez J, Priest H, Stokol T. Holoprosencephaly and Pure Red Cell Aplasia in a Feline Leukaemia Virus-Positive Kitten. J Comp Pathol 2016; 154:239-42. [PMID: 26897097 DOI: 10.1016/j.jcpa.2016.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 12/14/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
A 9-month-old, female, domestic longhair cat with severe anaemia tested positive for feline leukaemia virus (FeLV) and was humanely destroyed and submitted for necropsy examination. Gross findings included a non-divided rostral telencephalon, consistent with semilobar holoprosencephaly. Histological examination of the bone marrow revealed an almost complete absence of erythroid precursor cells, consistent with pure red cell aplasia, and mild to moderate myelofibrosis. This case demonstrates a very unusual central nervous system defect, as well as an atypical presentation of pure red cell aplasia, in a FeLV-positive kitten.
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Affiliation(s)
| | | | - H Priest
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - T Stokol
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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31
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Swann JW, Szladovits B, Glanemann B. Demographic Characteristics, Survival and Prognostic Factors for Mortality in Cats with Primary Immune-Mediated Hemolytic Anemia. J Vet Intern Med 2016; 30:147-56. [PMID: 26645865 PMCID: PMC4913623 DOI: 10.1111/jvim.13658] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 08/30/2015] [Accepted: 10/05/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Immune-mediated hemolytic anemia (IMHA) is uncommon in cats, but may result in severe disease. Demographic predispositions for development of the disease and prognostic factors for mortality have not been investigated previously. HYPOTHESIS/OBJECTIVES To explore possible demographic predispositions for development of primary IMHA in cats and to investigate possible prognostic factors for mortality. ANIMALS 107 client-owned cats with IMHA, of which 72 had primary IMHA and 35 had secondary IMHA, and 9,194 control cats. METHODS Data were collected retrospectively from records of cats with IMHA, defined by the presence of anemia and concurrent autoagglutination, ghost cells without oxidative damage on fresh blood smear, positive titer in a direct antiglobulin test, or evidence of phagocytosis of erythroid precursors in bone marrow. Odds ratios were calculated to assess the risk of development of primary IMHA in different demographic groups and Cox proportional hazards analysis was conducted to evaluate prognostic factors. RESULTS No sex or breed predisposition was identified for the development of primary IMHA in comparison to the control cats, but cats in the age range 2.1-5.9 years were predisposed. Higher total bilirubin concentration and age were significant negative prognostic factors and higher lymphocyte numbers and serum globulin concentration were positive prognostic factors in a multivariable model. CONCLUSIONS AND CLINICAL IMPORTANCE Young adult cats were more likely to develop primary IMHA than other groups, but no apparent male predisposition was identified in this study, contrary to previous reports. Several prognostic factors were identified, which may be helpful in guiding clinical practice in the future.
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Affiliation(s)
- J W Swann
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
| | - B Szladovits
- Department of Pathology and Pathogen Biology, Royal Veterinary College, University of London, London, UK
| | - B Glanemann
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
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Turinelli V, Gavazza A, Stock G, Fournel-Fleury C. Canine bone marrow cytological examination, classification and reference values: A retrospective study of 295 cases. Res Vet Sci 2015; 103:224-30. [PMID: 26679822 DOI: 10.1016/j.rvsc.2015.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/29/2015] [Accepted: 10/25/2015] [Indexed: 11/29/2022]
Abstract
Cytologic assessment of bone marrow with knowledge of the hemogram represents an effective method to investigate hemic tissue and its function. To determine the spectrum and prevalence of canine bone marrow disorders over a 2 year period in a diagnostic laboratory setting achieved through a standard approach to cytologic bone marrow assessment. A retrospective study of bone marrow fine needle aspirates sample preparations, blood smears, hemogram data and case records. Of the 295 bone marrow samples evaluated, 90 (30.5%) were nondiagnostic samples. Of the remaining samples, 25.1% were classified as hyperplasia of which most were granulocytic hyperplasia (58.1% of the total hyperplasia), 19.3% had no cytological abnormalities, 12.9% had malignant hemopathy and 7.8% had hypo-aplastic conditions. Only a small proportion of cases involved dysplasia (1.7%) and metastatic disease was detected in only one case (0.3%). Reference values of nucleated cells and the M/E ratio were calculated for normal and erythroid and granulocytic hyperplastic bone marrow. This study provides the spectrum and the prevalence of canine bone marrow disorders as well as a differential bone marrow cell counting and determination of reference intervals for diseases.
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Affiliation(s)
| | - Alessandra Gavazza
- Department of Veterinary Sciences, University of Pisa, via Livornese Lato Monte, 56122 Pisa, Italy.
| | - Graham Stock
- Vet Med Labor GmbH Division of IDEXX Laboratories, Mörikestraße 28/3, D-71636 Ludwigsburg, Germany
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33
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Kaye SW, Ossiboff RJ, Noonan B, Stokol T, Buckles E, Seimon TA, Morrisey J, de Matos R. Biliary Coccidiosis Associated With Immunosuppressive Treatment of Pure Red Cell Aplasia in an Adult Ferret (Mustela putorius furo). J Exot Pet Med 2015. [DOI: 10.1053/j.jepm.2015.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Furman E, Leidinger E, Hooijberg E, Bauer N, Beddies G, Moritz A. A retrospective study of 1,098 blood samples with anemia from adult cats: frequency, classification, and association with serum creatinine concentration. J Vet Intern Med 2014; 28:1391-7. [PMID: 25274437 PMCID: PMC4895589 DOI: 10.1111/jvim.12422] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 05/23/2014] [Accepted: 06/23/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Frequency and classification of anemia in terms of regeneration status and erythrocyte indices are not well described in cats. OBJECTIVE To determine frequency and regenerative status of anemia in samples from adult cats, to assess the sensitivity and specificity of macrocytosis and hypochromasia for detecting regenerative anemia (RA), and to evaluate the association of anemia with increased serum creatinine concentration (SC). STUDY POPULATION Laboratory records from 30,503 blood samples from cats (2003-2011). METHODS Clinicopathologic data reviewed retrospectively. Anemia defined as hematocrit (Ht) ≤27%, red blood cell count (RBC) ≤5.5 × 10(6)/μL and hemoglobin (Hb) ≤9.0 g/dL. RA defined by manual absolute reticulocyte count >50 × 10(3)/μL. Macrocytosis was defined as mean corpuscular volume (MCV) >55 fL and hypochromasia as mean corpuscular hemoglobin concentration (MCHC) <31 g/dL. Cutoff for increased serum creatinine concentration was 1.6 mg/dL. RESULTS Overall, 1,098 of 30,503 blood samples (3.6%) from cats fulfilled criteria for anemia, 633 of 1,098 (57.7%) classified as nonregenerative (NRA) and 465 of 1,098 (42.3%) as regenerative. RBC, Ht, and Hb were significantly lower in the RA compared to NRA group (P < .05). Sensitivity and specificity of the combined high MCV and low MCHC to detect samples with RA were 19.5 and 90.7%. SC was increased in 572 of the 1,098 anemic samples (52.1%) and in 11,121 of 29,405 of nonanemic samples (37.8%). CONCLUSIONS AND CLINICAL IMPORTANCE Majority of anemic samples were classified as NRA. Anemia was more severe in cats with RA. Erythrocyte indices were not sensitive indicators of RA.
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Affiliation(s)
- E. Furman
- Laboratory InVitro GmbHViennaAustria
| | | | | | - N. Bauer
- Faculty of Veterinary MedicineJustus‐Liebig‐University GiessenGiessenGermany
| | - G. Beddies
- Bayer Animal Health GmbHLeverkusenGermany
| | - A. Moritz
- Faculty of Veterinary MedicineJustus‐Liebig‐University GiessenGiessenGermany
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35
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Tan E, Abrams-Ogg A, Defarges A, Bienzle D. Automated Analysis of Bone Marrow Aspirates from Dogs with Haematological Disorders. J Comp Pathol 2014; 151:67-79. [DOI: 10.1016/j.jcpa.2014.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/17/2013] [Accepted: 02/14/2014] [Indexed: 02/08/2023]
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36
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Grimes CN, Fry MM. Nonregenerative anemia: mechanisms of decreased or ineffective erythropoiesis. Vet Pathol 2014; 52:298-311. [PMID: 24807888 DOI: 10.1177/0300985814529315] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In veterinary medicine, anemia without an appropriate compensatory hematopoietic response is termed nonregenerative. Nonregenerative anemia is a common clinical entity, occurring as a result of diminished or ineffective erythropoiesis in association with many types of pathology. This article reviews nonregenerative anemia in domestic animals, emphasizing mechanisms of disease, and also covers other conditions associated with nonregenerative anemia in people. Many aspects of nonregenerative anemia in animals are worthy of further investigation, from molecular mechanisms of disease to epidemiologic impacts.
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Affiliation(s)
- C N Grimes
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - M M Fry
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
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37
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Rosa CT, Pazzi P, Nagel S, McClure V, Christie J, Troskie M, Dvir E. Theileriosis in six dogs in South Africa and its potential clinical significance. J S Afr Vet Assoc 2014; 85:1114. [DOI: 10.4102/jsava.v85i1.1114] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 04/14/2014] [Accepted: 01/16/2014] [Indexed: 11/01/2022] Open
Abstract
Theileriosis is a tick-borne disease caused by a piroplasma of the genus Theileria that can causeanaemia and thrombocytopenia. Its clinical importance for dogs’ remains poorly understood,as only some develop clinical signs. In this study, physical and laboratory findings, treatment and outcomes of six client-owned diseased dogs presented at the Onderstepoort Veterinary Academic Hospital are described retrospectively. In the dogs, Theileria species (n = 4)and Theileria equi (n = 2) were detected by a polymerase chain reaction (PCR)-reverse blothybridisation assay in blood samples, whilst PCR for Babesia, Anaplasma and Ehrlichia were negative. The most common physical findings were pale mucous membranes (five out of six dogs), bleeding tendencies (five out of six dogs) and lethargy (three out of six dogs). All dogs were thrombocytopenic [median 59.5 x 109/L (range 13–199)] and five out of six dogs were anaemic [median haematocrit 18% (range 5–32)]. Bone marrow core biopsies performed in two dogs showed myelofibrosis. Theileriosis was treated with imidocarb dipropionate and the suspected secondary immune-mediated haematological disorders with prednisolone and azathioprine. Five dogs achieved clinical cure and post-treatment PCR performed in three out of five dogs confirmed absence of circulating parasitaemia. An immune-mediated response to Theileria species is thought to result in anaemia and/or thrombocytopenia in diseased dogs with theileriosis. A bleeding tendency, most likely secondary to thrombocytopenia and/or thrombocytopathy, was the most significant clinical finding in these cases. The link between thrombocytopenia, anaemia and myelofibrosis in theileriosis requires further investigation and theileriosis should be considered a differential diagnosis for dogs presenting with anaemia and/or thrombocytopenia in endemic tick-borne disease areas.
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Abstract
Since their introduction as pets several decades ago, ferrets have become an increasingly popular household pet. Great strides have been made in improving their diet and understanding common diseases (eg, insulinoma, hyperadrenocorticism, lymphoma) that affect them. With the frequency with which these conditions are seen, it sometimes is easy to forget that ferrets can be affected by other diseases. Some of these diseases, such as cryptococcosis, are known, but may be increasing in incidence and range, whereas others, such as hypothyroidism and pure red cell aplasia, may be underrecognized or underreported. This review highlights new and emerging diseases not already well reviewed in the literature.
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Affiliation(s)
- Nicole R Wyre
- Section of Exotic Companion Animal Medicine and Surgery, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Viviano KR, Webb JL. Clinical use of cyclosporine as an adjunctive therapy in the management of feline idiopathic pure red cell aplasia. J Feline Med Surg 2011; 13:885-95. [PMID: 21900029 PMCID: PMC10832976 DOI: 10.1016/j.jfms.2011.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2011] [Indexed: 01/17/2023]
Abstract
The clinical use of cyclosporine is described in a group of client-owned cats diagnosed with idiopathic pure red cell aplasia (PRCA). All 10 cats were treated with combinations of glucocorticoids and cyclosporine. Of the 10 cats, the eight for which follow-up data was available achieved and maintained remission for a median of 31 and 406 days, respectively. Therapy was reduced or discontinued in 7/8 cats; 2/7 maintained remission off therapy and 5/7 cats relapsed. Remission was reinduced in four cats, with 3/4 cats maintained long-term on low dose therapy. Adverse effects associated with cyclosporine therapy were responsive to dose reduction or drug withdrawal. Feline idiopathic PRCA was responsive to combination immunosuppressive therapy with glucocorticoids and cyclosporine. Relapse was common, particularly after drug discontinuation; therefore, most cats required maintenance long-term low dose therapy.
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Affiliation(s)
- Katrina R Viviano
- Department of Medical Sciences, University of Wisconsin-Madison, School of Veterinary Medicine, Madison, WI 53711, USA.
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40
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Hodges J, Christopher MM. Diagnostic accuracy of using erythrocyte indices and polychromasia to identify regenerative anemia in dogs. J Am Vet Med Assoc 2011; 238:1452-8. [PMID: 21627508 DOI: 10.2460/javma.238.11.1452] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine diagnostic accuracy of using erythrocyte indices and polychromasia to identify regenerative anemia in dogs. DESIGN Retrospective and prospective cross-sectional study. ANIMALS 4,521 anemic dogs. PROCEDURES CBC results obtained between July 2002 and July 2008 by use of an automated laser-based flow cytometric hematology analyzer from dogs with Hct values ≤ 35% were retrieved. Sensitivity, specificity, accuracy, and predictive values of using erythrocyte indices and polychromasia to identify regeneration were determined, with a reticulocyte count > 65,000 reticulocytes/μL considered the gold standard. Similarly, 134 blood samples from anemic dogs were analyzed prospectively with an in-house electrical impedance analyzer. RESULTS Of 4,387 dogs with samples analyzed retrospectively, 1,426 (32.5%) had regenerative anemia. Of these, 168 (11.8%) had macrocytic hypochromic anemia. High mean cell volume and low mean cell hemoglobin concentration had low sensitivity (11%), high specificity (98%), and moderate accuracy (70%) when used to identify regenerative anemia. Use of polychromasia alone had an accuracy of 77%, and use of polychromasia combined with a high RBC distribution width (RDW) had an accuracy of 79%. Results obtained with the in-house analyzer were similar. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that most regenerative anemias in dogs were not macrocytic hypochromic. Polychromasia, with or without high RDW, was a more accurate indicator than other erythrocyte indices of regenerative anemia. To avoid a false diagnosis of nonregenerative anemia, a blood smear should be evaluated in anemic dogs when a reticulocyte count is not available.
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Affiliation(s)
- Joanne Hodges
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
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41
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Piek CJ. Canine idiopathic immune-mediated haemolytic anaemia: a review with recommendations for future research. Vet Q 2011; 31:129-41. [DOI: 10.1080/01652176.2011.604979] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Malka S, Hawkins MG, Zabolotzky SM, Mitchell EB, Owens SD. Immune-mediated pure red cell aplasia in a domestic ferret. J Am Vet Med Assoc 2010; 237:695-700. [DOI: 10.2460/javma.237.6.695] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sinnott VB, Otto CM. Use of thromboelastography in dogs with immune-mediated hemolytic anemia: 39 cases (2000-2008). J Vet Emerg Crit Care (San Antonio) 2009; 19:484-8. [PMID: 19821891 DOI: 10.1111/j.1476-4431.2009.00455.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyze thromboelastograms (TEGs) of naturally occurring cases of immune-mediated hemolytic anemia (IMHA) in order to identify whether a hypercoagulable state was present and whether its presence was associated with differences in survival. DESIGN Retrospective study spanning January 2000 to June 2008. Medical records of dogs were evaluated. Endpoints were considered death or discharge from the hospital. SETTING Academic teaching hospital. ANIMALS Thirty-nine dogs with a diagnosis of IMHA and at least one TEG performed during hospitalization were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Four values were evaluated from the TEG: the R time (R), K time (K), alpha angle (alpha), and maximum amplitude. From these values, a coagulation index (CI) was calculated to classify patients as normocoagulable, hypercoagulable, or hypocoagulable. Thirty-three of 39 patients were hypercoagulable based on the CI. The 6 remaining dogs were normocoagulable. The patients with a normocoagulable CI had an increased mortality rate (100%) when compared with the hypercoagulable patients using Fisher's exact test (P=0.02). Additionally, prolongation of partial thromboplastin time did not preclude hypercoagulable TEG values. CONCLUSIONS The majority of dogs with IMHA were hypercoagulable as measured by TEG. A normal CI was associated with a worse outcome in this patient population. TEG may provide additional and complementary information to prothrombin time and partial thromboplastin time relating to coagulation status in dogs with IMHA and may help predict prognosis and potentially guide clinical decisions to utilize anticoagulant drugs.
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Affiliation(s)
- Virginia B Sinnott
- Department of Emergency and Critical Care, The University of Pennsylvania School of Veterinary Medicine, Matthew J Ryan Veterinary Hospital, Philadelphia, PA, USA.
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