Coombs’, haemoplasma and retrovirus testing in feline anaemia

Pulmonary thromboembolism due to immune-mediated hemolytic anemia in a cat: A serial study of hematology and echocardiographic findings

Pulmonary thromboembolism (PTE) secondary to immune-mediated hemolytic anemia (IMHA) is rarely diagnosed in cats. In this report, a 3-year-old cat was referred to our private hospital with dyspnea, anorexia, and anemia. On the thoracic radiography, cardiac enlargement and pulmonary edema were noted. Echocardiography revealed right ventricular and right atrium enlargement with mild tricuspid regurgitation (tricuspid regurgitation velocity 3.28 m/s). A thrombus was recognized in the main pulmonary artery on the right parasternal short-axis view. Blood examination suggested regenerative anemia and autoagglutination. The findings suggested immune-mediated hemolytic anemia and PTE. Antithrombotic therapy (dalteparin) and immunosuppressive therapy (prednisolone) were administered under oxygen supplementation in the ICU cage. After treatment, regenerative anemia and right-heart failure were improved. During follow-up, the cat remained hemodynamically stable, and the owner reported no cardiac-related clinical signs. Further blood examination confirmed the anemia was improved. Prednisolone was discontinued on Day 56, and the cat continues in good health, administered only mycophenolate mofetil. The clinical outcome of PTE secondary to the IMHA throughout 100 days of periodical observation was reported.

2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1- Defining populations at risk

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.

Presumed immune-mediated haemolytic anaemia associated with pregnancy in a cat

Case summary

A 7-year-old female entire Birman presented with acute-onset haemorrhagic vulvar discharge. Moderate, normocytic, normochromic, non-/pre-regenerative anaemia, along with a moderate mature neutrophilia, were seen on haematology. Saline test for agglutination was positive. No haemotropic mycoplasmas were identified. Serum biochemistry revealed severe hyperbilirubinaemia. Retroviral testing was negative. Serology for toxoplasmosis revealed a titre of 1:512. Abdominal ultrasound identified a large uterus, containing at least three advanced-stage fetuses, two of which failed to exhibit independent motion or cardiac activity. Ovariohysterectomy was performed. Histology demonstrated mild, multifocal suppurative placentitis, with Gram staining revealing no evidence of bacteria. Complete resolution of the anaemia was seen within 1.5 months of ovariohysterectomy.

Relevance and novel information

Immune-mediated haemolytic anaemia (IMHA) in association with pregnancy has not been previously reported in cats. This case represents a potential novel cause for IMHA in cats, which resolved following ovariohysterectomy.

Update on Feline Hemoplasmosis

"The wall-less, hemotropic, mycoplasma species Mycoplasma haemofelis, "Candidatus Mycoplasma turicensis" and, to a lesser extent, "Candidatus Mycoplasma haemominutum" have the potential to induce clinical hemolytic anemia in infected cats. Prevalence varies markedly between infecting species, complicated by a chronic carrier state. Accurate and prompt confirmation of infection and identification of the infecting hemoplasma species enables appropriate antibiotics (eg, tetracycline; fluoroquinolone) to be prescribed. Although cats with hemoplasmosis respond rapidly to antibiosis and supportive care, initial monotherapy treatment rarely results in clearance of infection. A protocol now exists for the clearance of the most pathogenic feline hemoplasma M haemofelis."

ACVIM consensus statement on the diagnosis of immune-mediated hemolytic anemia in dogs and cats

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.

Demographic Characteristics, Survival and Prognostic Factors for Mortality in Cats with Primary Immune-Mediated Hemolytic Anemia

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.

Haemoplasmas: lessons learnt from cats

The haemotropic mycoplasmas (haemoplasmas) are a group of bacteria that can induce anaemia in a wide variety of mammals, including domestic cats and wild felids. Different feline haemoplasma species of varying pathogenicity exist, with the more pathogenic Mycoplasma haemofelis (Mhf) capable of inducing severe haemolytic anaemia, whilst 'Candidatus Mycoplasma haemominutum' (CMhm) and 'Candidatus Mycoplasma turicensis' (CMt) are infrequently associated with clinical disease. Chronic haemoplasma infections are common and cats are frequently infected by two or more haemoplasmas, complicating the clinical picture. The natural route of transmission of haemoplasma infection between cats has not yet been determined; however, experimental transmission has been demonstrated via both oral and parenteral administration of infected blood. To date the haemoplasmas have been unable to be cultured in vitro, and accurate diagnosis is currently reliant on detection of bacterial DNA using PCR assays. Treatment of clinical haemoplasmosis is focussed on supportive care in combination with empirical treatment with antimicrobials (tetracyclines or fluoroquinolones). A significant number of asymptomatic cats are positive for haemoplasma infection. These cats may play a role in the maintenance of haemoplasma infection within a population, and need to be considered when choosing potential blood donors. Use of PCR assays has provided an accurate method of diagnosing haemoplasma infection and quantifying response to therapy, including in non-feline host animals, as presumed zoonotic haemoplasma infections are now being documented. Recent advances in genome sequencing techniques have allowed the whole genome sequences of the feline haemoplasmas Mhf and CMhm to be derived, as well as a number of non-feline haemoplasma species. These data have aided the identification of antigens for use in the development of serological tests, allowed the proteomic study of haemoplasmas and provided clues as to how the haemoplasmas can persist within the host. Future areas of study include investigation of their zoonotic potential, mechanisms of immune system evasion and transmission of these emerging pathogens.

A retrospective study of 180 anaemic cats: features, aetiologies and survival data

The study comprised 180 anaemic cats. Descriptive and survival data were obtained. Cats were classified by aetiology of anaemia development and degenerative, anomalous, metabolic, miscellaneous, neoplastic, infectious, inflammatory, immune-mediated, toxic, traumatic or vascular disease (DAMNITV) classification and anaemia severity. Sixty-four (35.6%) cats had mild [packed cell volume (PCV)/haematocrit (HCT) 20-24.9%], 58 (32.2%) moderate (14-19.9%), 23 (12.8%) severe (11-13.9%) and 35 (19.4%) very severe (<10.9%) anaemia. By aetiology of anaemia development, bone marrow (BM) abnormalities were more common (95, 52.8%) than haemorrhage (37, 20.6%) or haemolysis (19, 10.6%). By DAMNITV classification, infectious diseases were more common (39, 21.7%) than neoplasia (36, 20%), metabolic (21, 11.7%), trauma (15, 8.3%), miscellaneous (14, 7.8%), inflammatory (11, 6.1%), immune-mediated (11, 6.1%), anomalous (8, 4.4%), toxic (2, 1.1%) or vascular disease (1, 0.6%). BM abnormalities were significantly associated with more severe anaemia (P = 0.003). Most cats (112, 62.2%) survived to discharge whereas 55 (30.6%) were euthanased and 13 (7.2%) died. Survival to discharge was not associated with anaemia severity but was associated significantly with aetiology of anaemia development (P = 0.046), as cats with haemolysis were more likely to survive to discharge than cats with BM abnormalities. Survival to discharge was also associated significantly with DAMNITV classification (P = 0.010), with cats with neoplasia being less likely, and cats with immune-mediated disease more likely, to survive to discharge. Cox regression analysis found that survival was not associated with anaemia severity, but was associated with DAMNITV classification (P = 0.011) and age (P = 0.082), with cats with immune-mediated disease and younger cats more likely to survive.

Quantification of the humoral immune response and hemoplasma blood and tissue loads in cats coinfected with 'Candidatus Mycoplasma haemominutum' and feline leukemia virus

'Candidatus Mycoplasma haemominutum' (CMhm) is a hemotropic mycoplasma (aka hemoplasma) of domestic cats and wild felids. In a transmission study, we exposed eight specified pathogen-free cats to blood from Iberian lynxes (Lynx pardinus) infected with CMhm. The cats were coinfected with feline leukemia virus (FeLV) from an Iberian lynx or with a prototype FeLV. The goal of the present study was to quantify the humoral immune response to CMhm and to identify potential target tissues and sequestration sites. Antibodies were measured by a recombinant antigen-based enzyme-linked immunosorbent assay, and blood and tissue loads were quantified using real-time PCR. Seven out of eight cats became CMhm-infected; all of these cats seroconverted between 3 and 13 weeks after inoculation. Antibody levels correlated with the CMhm blood loads. The peak CMhm blood loads were inversely correlated with the incubation period. PCR-positive results were found in all 24 tissues tested but not for all samples. Although all tissues were PCR-positive in one cat euthanized ten weeks after infection, many tissues tested negative in six cats euthanized at week 20 after infection. In several cats, the spleen, lung, liver, heart and aorta contained more copies than expected given the tissue's blood supply, but most tissues contained fewer copies than expected. In conclusion, this is the first study to quantify the humoral immune response and tissue loads in CMhm-FeLV-coinfected cats. The tissue loads appeared to correlate with the duration of infection and with the blood loads, but no evidence of significant CMhm tissue sequestration was found.

Good agreement of conventional and gel-based direct agglutination test in immune-mediated haemolytic anaemia

Background

The aim of this study was to compare a gel-based test with the traditional direct agglutination test (DAT) for the diagnosis of immune-mediated haemolytic anaemia (IMHA).

Methods

Canine (n = 247) and feline (n = 74) blood samples were submitted for DAT testing to two laboratories. A subset of canine samples was categorized as having idiopathic IMHA, secondary IMHA, or no IMHA.

Results

The kappa values for agreement between the tests were in one laboratory 0.86 for canine and 0.58 for feline samples, and in the other 0.48 for canine samples. The lower agreement in the second laboratory was caused by a high number of positive canine DATs for which the gel test was negative. This group included significantly more dogs with secondary IMHA.

Conclusions

The gel test might be used as a screening test for idiopathic IMHA and is less often positive in secondary IMHA than the DAT.

Coombs' testing and its diagnostic significance in dogs and cats

The Coombs' test can detect both immunoglobulin and complement on the surface of RBCs, and as such can be of value as an aid in the diagnosis of IMHA. Techniques that may improve sensitivity include use of monovalent reagents, increased dilutions of antiglobulin to avoid a prozone effect, and testing at 4°C. These techniques are not without controversy, and positive tests should always be interpreted in the presence of other clinical and hematologic evidence for IMHA. Alternate techniques, such as flow cytometry, can improve detection of RBC-bound immunoglobulin, but require a flow cytometer and further standardization between laboratories.

Feline leukemia virus outbreak in the critically endangered Iberian lynx (Lynx pardinus): high-throughput sequencing of envelope variable region A and experimental transmission

The Iberian lynx is the most endangered felid species. During winter/spring 2006/7, a feline leukemia virus (FeLV) outbreak of unexpected virulence killed about 2/3 of the infected Iberian lynxes. All FeLV-positive animals were co-infected with feline hemoplasmas. To further characterize the Iberian lynx FeLV strain and evaluate its potential virulence, the FeLV envelope gene variable region A (VRA) mutant spectrum was analyzed using the Roche 454 sequencing technology, and an in vivo transmission study of lynx blood to specified-pathogen-free cats was performed. VRA mutations indicated weak apolipoprotein B mRNA editing enzyme and catalytic polypeptide-like cytidine deaminase (APOBEC) restriction of FeLV replication, and variants characteristic of aggressive FeLV strains, such as FeLV-C or FeLV-A/61C, were not detected. Cats exposed to FeLV/Candidatus Mycoplasma haemominutum-positive lynx blood did not show a particularly severe outcome of infection. The results underscore the special susceptibility of Iberian lynxes to infectious diseases.

Feline blood transfusions: A pinker shade of pale

PRACTICAL RELEVANCE

blood transfusions are a potentially life-saving procedure that are within the reach of most small animal practitioners. Only minimal equipment is required.

PATIENT GROUP

any cat with clinical signs attributable to a reduced red blood cell mass that is affecting oxygen transport (as a result of reduced packed cell volume or acute blood loss) is a potential candidate for a transfusion.

CLINICAL CHALLENGES

although the principles of transfusion medicine are not complicated, there can be fatal consequences if certain steps are omitted.

DIAGNOSTICS

blood typing kits and blood filters are readily available from veterinary wholesalers, laboratories and blood banking services.

EVIDENCE BASE

over the past three decades, a substantial body of clinical research and reports has built up covering feline blood types and transfusion medicine. This article draws on that research to provide clinical guidance aimed at all veterinarians in feline or small animal practice who either currently practise transfusion medicine or plan to do so.