C as e St ud i e s I n C l ini ca l I m m uno l o gy 267

CASE 1: CANINE IMMUNE-MEDIATED

HAEMOLYTIC ANAEMIA Parameter Value Normal range
PCV 0.13 0.35–0.55 l/l
Signalment Haemoglobin 50 120–180 g/l
Six-year-old, male English springer spaniel
(Figure 1a; photo courtesy S Warman). Red blood cells 1.68 5.4–8.0 × 1012/l
MCV 80.1 65–75 fl
MCHC 373 340–370 g/l
1a MCH 29.8 22–25 pg
Absolute 280 ≤60 × 109/l
reticulocytes
Platelets 251 170–500 × 109/l
White blood cells 19.8 5.5–17 × 109/l
Neutrophils 15.5 3–11.5 × 109/l
Band neutrophils 1.67 0–0.3 × 109/l
Lymphocytes 0.84 0.7–3.6 × 109/l
Monocytes 1.68 0.1–1.5 × 109/l
Eosinophils 0.3 0.2–1.4 × 109/l
Basophils 0.0 0–0.1 × 109/l
Nucleated red 2.9 × 109/l
History and physical examination blood cells
The dog is presented with a 2-week history of
increasing lethargy, weakness and reduced appetite.
There have been no recent changes to the lifestyle of
the animal and no recent administration of drugs or
vaccines. The dog has lived all of its life in northern
Europe in an area non-endemic for arthropod-borne
infectious diseases such as babesiosis, ehrlichiosis and
leishmaniosis. Clinical examination reveals pallor of 1b
the oral and conjunctival mucous membranes, mild
pyrexia and mild elevation in heart and respiratory
rate. Abdominal palpation reveals enlargement of the
spleen.

Diagnostic procedures
Routine haematology, serum biochemistry and N
urinalysis are performed initially. Haematological S
examination (see below) reveals a strongly regenerative
anaemia and leucocytosis due to a left shift neutrophilia
and mild monocytosis. Examination of the blood smear
reveals polychromasia, anisocytosis and spherocytosis
with prominent nucleated erythrocytes (Figure 1b). N, nucleated RBC; S, spherocyte.

© 2014 by Taylor & Francis Group, LLC

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 268 Chapter 22

Serum biochemistry and protein electrophoresis This dog has primary idiopathic (autoimmune)
reveal the presence of a mild polyclonal IMHA in which IgG antibody attached to the
hypergammaglobulinaemia, but there is no significant surface of erythrocytes mediates removal and
elevation in serum bilirubin or liver enzymes. partial phagocytosis (leading to the formation of
Urinalysis is unremarkable. Survey radiographs of spherocytes) by macrophages within the spleen/liver
the thorax and abdomen are obtained, but they reveal (extravascular haemolysis). This is an example of a
no abnormalities apart from the diffuse enlargement type II hypersensitivity reaction (see Chapter 12).
of the spleen identified on clinical examination. On The diffuse splenomegaly in this dog is likely
the basis of the haematological data, a Coombs test attributed to the combination of erythrocyte removal
and a serum ANA are performed. The Coombs test is and extramedullary haematopoiesis. The anaemia
positive (see below) and the ANA test is negative. is strongly regenerative and the dog has a relatively
chronic-onset disease for which it compensates
physiologically (elevated heart and respiratory rate).
Serum hypergammaglobulinaemia likely reflects
Antiserum Titre at 37°C Titre at 4°C immune activation.
Polyvalent 640 1,280
Coombs reagent Treatment and prognosis
Anti-dog IgG 2,560 2,560 This dog was treated with an immunosuppressive
dose of oral prednisolone. A good response to therapy
Anti-dog IgM 0 0
was observed and the drug was slowly tapered and
Anti-dog 0 0 eventually withdrawn (see Chapter 21). The owner
complement C3 was warned that the pattern for IMHA is of a relapsing
disease, so the dog should be closely monitored by
regular PCV checks.

Diagnosis and immunopathology

Springer spaniels have a recognized genetic
predisposition to IMHA. Common underlying
trigger factors (drugs, vaccination, infectious
disease or neoplasia) are ruled out by historical and
diagnostic investigation. The haematological findings
are strongly suggestive of IMHA, in particular the
presence of spherocytosis. This suspicion is confirmed
by the Coombs test, which demonstrates the presence
of a warm-reactive IgG antibody associated with the
red cells in this dog.

© 2014 by Taylor & Francis Group, LLC

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