Heinz body haemolytic anaemia in a dog secondary to ingestion of a zinc toy: a case report

A 6-year-old Labrador retriever was referred for investigation of severe lethargy and suspected immune-mediated haemolytic anaemia. Clinical examination revealed pale mucous membranes and jaundice. Haematology demonstrated large numbers of Heinz bodies and a marked anaemia, which was strongly regenerative. Serum zinc concentrations were markedly elevated. Analysis of a metal toy vomited by the dog 3 days prior to presentation revealed it to be composed of almost pure zinc. A diagnosis of haemolytic anaemia secondary to acute zinc toxicity was made and supportive therapy instigated. There was a subsequent decrease in numbers of Heinz bodies and a rise in the haematocrit, and the dog made an uneventful recovery. Acute zinc toxicity resulting in haemolytic anaemia is rarely observed, and this case was also unusual in that the main clinicopathological finding was the presence of numerous Heinz bodies without other evidence of oxidative damage to red blood cells.     

Anaplastic and aggressive subcutaneous sarcoma in a seven-month-old dog

A seven-month-old female, Italian hound which was presented with anorexia, dyspnoea and weight loss showed two subcutaneous masses at physical examination. Radiographs showed multiple opacities in the lungs, thorax, liver and spleen, and cytology showed discrete pleomorphic cells, with variable nuclear : cytoplasmic ratio, foamy cytoplasm and round to oval nuclei. Incisional biopsy histology showed the infiltrative proliferation of highly pleomorphic spindle to roundish large cells, discrete or arranged in a storiform pattern, with scattered multinucleated giant cells. Immunohistochemistry exhibited strong positivity for vimentin and mild labelling for alpha-smooth muscle actin and lysozyme; other mesenchymal or histiocytic lineage markers stained negatively. Because of the poor prognosis, the owner elected euthanasia. Post-mortem examination confirmed massive metastatic spread. Cytology, histology and immunohistochemistry suggested the diagnosis of anaplastic sarcoma with giant cells, although disseminated histiocytic sarcoma was a reliable differential diagnosis. The authors underline the difficulties in definitively categorising poorly differentiated sarcomas, even if a large panel of markers is applied.     

Intestinal leiomyosarcoma in a cat

Intramural ileocaecocolic leiomyosarcoma is described in an elderly neutered male domestic shorthaired cat with poor appetite and weight loss. Histological examination of the resected lesion revealed a poorly differentiated soft tissue sarcoma and a diagnosis of leiomyosarcoma was confirmed by positive immunohistochemical staining for vimentin and a-smooth muscle actin. Postoperative survival time was 102 days before local recurrence justified euthanasia.     

Haemolytic anaemia as a complication following colic surgery in a 10‐year‐old Arabian stallion

Immune‐mediated haemolytic anaemia is rare in the horse. This case report discusses the clinical presentation and treatment of this condition in an Arabian stallion following abdominal surgery for large colon volvulus. On Day 10 of hospitalisation the stallion's PCV dropped by 10% whilst his total solids remained stable, consistent with haemolytic anaemia. The stallion was treated with whole blood transfusions and dexamethasone and recovered to be discharged on Day 42. This is an interesting example of immune mediated haemolytic anaemia associated with a complicated gastrointestinal condition. It demonstrates the wide variety of potential aetiologies underlying a haemolytic episode and the necessity for expedient treatment.     

Anuric renal failure in a dog after red-bellied black snake (Pseudechis porphyriacus) envenomation

A case of Red-bellied Black snake envenomation resulting in intravascular haemolytic anaemia, rhabdomyolysis and anuric renal failure is described in the dog. A 12-year-old female desexed Golden Retriever was presented with a 15 hour history of profuse salivation, progressive lethargy, obtundence, inappetence and collapse. Significant findings on clinical examination were pallor, icterus, tachypnoea and dyspnoea with increased respiratory sounds and crackles in all lung fields. Generalised abdominal and muscular pain was apparent and dark red-brown urine was present around the perineal region. A diagnosis of Red-bellied Black snake (Pseudechis porphyriacus) envenomation was made and the dog was treated with intravenous fluid therapy, Tiger/Brown snake antivenom, packed red cell transfusions and Intermittent Positive Pressure Ventilation. Continued clinical deterioration occurred and a diagnosis of acute renal failure secondary to myohaemoglobinuric pigmenturia was made 12 hours after admission. Intensive treatment was attempted with diuresis and volume expansion. Oliguria and subsequent anuria ensued and the dog was euthanased due to a grave prognosis and lack of clinical response to treatment. Necropsy examination revealed muscular necrosis, accumulation of fluid in the thoracic and peritoneal cavities, and marked renal tubular necrosis with intraluminal occlusion secondary to pigmentary casts.     

Gastric carcinoma associated with Menetrier's‐like disease in a West Highland white terrier

A seven‐year‐old West Highland white terrier was presented for chronic vomiting associated with mild regenerative anaemia and hypoalbuminaemia. Further examination showed a giant polypoid cerebriform mass located in the lesser curvature of the stomach. Partial gastrectomy was performed and histology was consistent with hypertrophic gastritis with typical features of Ménétrier's disease. Five years after surgery, the dog was re‐examined for recurrence of vomiting episodes. Endoscopy showed ulceration of the lesser curvature of the stomach and histological analysis revealed a poorly differentiated superficial gastric carcinoma surrounded by hypertrophic gastritis. To the authors’ knowledge, this is the second time that coexistence of these two types of lesions is reported, suggesting that recurrence of gastritis could be the starting point of the tumoural process.     

Erythrocyte response to Trypanosoma brucei in experimentally infected dogs.

Trypanosoma brucei infection produced an acute and fatal disease in Nigerian mongrel dogs due to a rapidly developing anaemia. Infected dogs responded with increased reticulocytosis, which was not sustained with chronicity. In comparison the response to artificially-induced haemolytic anaemia was progressive, marked and sustained. The anaemia of T. brucei infection of dogs was either normocytic normochromic in acute infection or microcytic normochromic in chronic infection. Artificially-induced haemolytic anaemia was either macrocytic normochromic or normocytic normochromic. The erythropoietic potential of plasma in vivo in mice increased in T. brucei-infected dogs except at the terminal parasitaemia. The anaemia in Trypanosoma brucei-infected dogs is therefore initially responsive but becomes poorly involved with chronicity.     

Immune-mediated haemolytic anaemia in two sibling cats associated with multicentric lymphoblastic infiltration

Immune-mediated haemolytic anaemia associated with multicentric lymphoblastic infiltration is reported in two sibling cats. Both cats presented at under 16 months of age with clinical signs of acute anaemia. In each case there was autoagglutination, a positive Coombs' test and the anaemia was regenerative. At presentation, both cats were negative for FeLV antigen. In each case, the disease proved fatal within 2 months of the initial diagnosis. In both cases, T-lymphoblastic infiltration of bone marrow, liver and spleen was found at post-mortem examination.     

An unusual presentation of suspected oedema disease of swine in Kenya

From a group of 11 recently weaned pigs, 4 were reported to be sick. Clinical examination of the sick pigs revealed marked dyspnoea, bluish-red discolouration of the skin, incoordination and difficulty in walking. Bacteriological examination of the gut contents of 2 pigs that had died earlier yielded pure cultures of haemolytic Escherichia coli. Post mortem examination of the remaining 2 pigs that died subsequently revealed progressive pulmonary collapse. One of these also showed subcutaneous oedema of the head and marked oedema of the mesentery of the spiral colon and oedema of the brain. Microscopically there was pulmonary alveolar collapse and degenerative changes in the liver. On the basis of the clinical signs, isolation of haemolytic E. coli and the post mortem findings, a diagnosis of oedema disease was made.     

Serum cardiac troponin I in dogs with primary immune-mediated haemolytic anaemia

Objectives : The assessment of serum cardiac troponin I concentrations in dogs with a range of nonprimary cardiac illnesses has revealed that cardiac myocyte damage is commonplace in many canine diseases. Whilst it is well established that dogs with fatal immune‐mediated haemolytic anaemia frequently have cardiac pathology based on post‐mortem examinations, there is limited information on the incidence of cardiac myocyte damage in this population of dogs. Methods : Serum cardiac troponin I concentrations were measured in 11 healthy dogs, 27 dogs with primary haemolytic anaemia and 49 hospitalised dogs without primary cardiac or haematological disorders. Results : Dogs with primary haemolytic anaemia have higher serum concentrations of cardiac troponin I than hospitalised ill dogs (P<0.005) and healthy dogs (P<0.01). Using a cut‐off of less than 0.1 ng/mL, 20 of 27 dogs with primary haemolytic anaemia had increased serum cardiac troponin I concentrations, which was a significantly higher proportion compared to the hospitalised ill dogs (P<0.001, 16 out of 49 dogs) and healthy dogs (P<0.05, 3 out of 11 dogs). Clinical Significance : Dogs with primary haemolytic anaemia have a higher incidence of subclinical myocyte damage than healthy dogs or dogs with non‐haematological or primary cardiac illnesses. The prognostic significance of increased serum cardiac troponin I concentrations in dogs with primary haemolytic anaemia merits further investigation.     

Progressive neurological signs associated with systemic mastocytosis in a dog

A 9-year-old dog was presented with nonregenerative anaemia and severe thrombocytopenia, diarrhoea, spinal hyperalgesia and progressive hindlimb paresis. A moderately well differentiated cutaneous mast cell tumour (MCT) was removed from the skin of the right elbow along with the enlarged right prescapular lymph node. Due to deterioration of the dog's neurological condition, euthanasia was performed. On necropsy examination, haemorrhage and accumulations of poorly differentiated mast cells were found in the lumbosacral region and cauda equina. This article describes an unusual presentation of systemic mastocytosis and the previously unreported finding of metastasis of mast cells to the spinal cord.     

Haemolytic anaemia and bilateral uveitis associated with leptospirosis in a 6‐year‐old Quarter Horse gelding

A 6‐year‐old Quarter Horse gelding was presented for bilateral uveitis resulting in vision loss as well as icterus. Anaemia with autoagglutination was consistent with a presumptive immune‐mediated haemolytic anaemia. Urinary PCR was positive for Leptospira spp. and microscopic agglutination test (MAT) titres were elevated to multiple serovars supportive of a diagnosis of leptospirosis. Treatments included broad spectrum antibiotics and aggressive anti‐inflammatory medications. While the horse was hospitalised, the development of bilateral corneal ulcers precluded the use of topical ophthalmic anti‐inflammatories for a number of days. The corneal ulceration resolved, vision returned in both eyes and the immune‐mediated haemolytic anaemia resolved. After 9 days of hospitalisation, oral minocycline was administered for 2 weeks at home as well as low dose oral flunixin meglumine and topical ophthalmic diclofenac and atropine. This case represents the first published case of haemolytic anaemia associated with leptospirosis in a horse.     

Treatment of a poorly differentiated sarcoma in the oropharynx of a horse

A 10-year-old Thoroughbred mare was referred to Tennessee Equine Hospital for evaluation and treatment of a subepiglottic mass. Physical and laboratory examinations revealed no other abnormalities. The tumour was excised through a laryngotomy site using transendoscopic laser and sharp excision. Histological evaluation revealed a poorly differentiated sarcoma with features of a leiomyosarcoma, a rarely identified neoplasm in the oropharynx of the horse. The mare developed intermittent dorsal displacement of the soft palate (iDDSP) after surgery but was able to resume full training. There was no evidence of regrowth 8 months post-operatively.     

Undifferentiated sarcoma resolved by forelimb amputation and prosthesis in a radiated tortoise (Geochelone radiata).

An adult female, radiated tortoise (Geochelone radiata) presented with a grossly swollen left forelimb that restricted mobility and prevented limb withdrawal. Clinical pathology revealed leukopenia (1.9 x 10(9)/L) and hyperproteinemia (69 g/L) that on protein electrophoresis was attributed to increased acute-phase proteins in the alpha fraction (26.4 g/L). Biopsy revealed a poorly differentiated soft tissue sarcoma. Surgical amputation at the proximal humerus was curative. To encourage postoperative mobility, a novel methylmethacrylate prosthesis, molded from a lubricated transected tennis ball, was adhered to the plastron using three cortical bone screws. This is the first recorded case of a sarcoma in the genus Geochelone.     

Cutaneous Alternaria infectoria infection in a dog in association with therapeutic immunosuppression for the management of immune‐mediated haemolytic anaemia

A 4‐year‐old, ovariohysterectomized, English springer spaniel on immunosuppressive therapy was re‐examined for the review of its immune‐mediated haemolytic anaemia and the recent development of skin lesions. For the 3 months since hospital discharge, the dog had been receiving 1.3 mg/kg prednisolone and 2.6 mg/kg ciclosporin, both administered orally twice daily. Physical examination revealed hepatomegaly and multiple, purulent, crusting, erosive to ulcerative lesions over different body areas. Onychorrhexis had occurred on one digit and the underlying corium had blackened. There were two proliferative and one plaque‐like lesions in the mouth. Thick walled fungal hyphae were detected in impression smears from all skin lesions and staining with periodic acid–Schiff’s stain confirmed the presence of multiple fungal hyphae and spores in all biopsies examined. Fungal culture isolated a heavy, pure growth of an Alternaria sp. which was identified as A. infectoria by sequencing the internal transcribed spacer 1 region of the rRNA gene. The animal’s condition prevented detailed investigation of the oral lesions. Withdrawal of the ciclosporin and reduction of the prednisolone dosage resulted in spontaneous resolution of the skin lesions within 40 days. Further gradual decrements in the prednisolone dosage to zero were carried out without recurrence of the immune‐mediated haemolytic anaemia. After 12 months, there has been no recurrence of either the skin lesions or the anaemia. To the authors’ knowledge, this is the first reported case of A. infectoria infection in a dog.     

Neutrophilic dermatitis and immune-mediated haematological disorders in a dog: suspected adverse reaction to carprofen

This report describes the clinical and pathological findings of a suspected idiosyncratic adverse drug reaction in a young dog. The patient presented with sudden onset, severe skin lesions together with episodes of collapse. Investigations revealed a neutrophilic dermatitis with vasculitis, immune-mediated haemolytic anaemia and thrombocytopenia. Similar pathology has been described in human cases of Sweet's syndrome. The chronology of events suggested an adverse drug reaction to carprofen, although two antibiotics had been prescribed within the dog's recent history. Lymphocyte transformation tests were performed and tended to exclude both antibiotics as the cause of the reaction. To the authors' knowledge, lymphocyte transformation tests have not previously been described with regard to drug hypersensitivity assessment in the veterinary literature, and this is the first peer-reviewed case report of neutrophilic dermatitis and vasculitis with immune-mediated haemolytic anaemia and thrombocytopenia occurring as a suspected adverse drug reaction to carprofen in the dog.     

Evaluation of platelet activation in canine immune-mediated haemolytic anaemia

Objectives : To establish whether heightened platelet activation is a common feature of canine immune-mediated haemolytic anaemia, and to evaluate the hypothesis that platelet activation plays a role in the pathogenesis of thromboembolism. Methods : Using whole-blood flow-cytometric analysis, the proportion of activated platelets and platelet-leucocyte aggregates in blood samples from 14 dogs with immune-mediated haemolytic anaemia and 14 healthy dogs was calculated. General linear models with binomial errors were used to compare groups. Results from the immune-mediated haemolytic anaemia-affected dogs were then correlated with established risk factors for thromboembolism in canine immune-mediated haemolytic anaemia, D-dimer concentration and antithrombin activity. Results : There was a strong correlation between platelet activation and severe thrombocytopenia, with heightened platelet activation being observed predominantly in severely thrombocytopenic dogs. Clinical Significance : Dogs with immune-mediated haemolytic anaemia, particularly those with concurrent severe thrombocytopenia, are likely to have heightened platelet activation, which may play a role in the pathogenesis of thromboembolism.     

A case of intravascular lymphoma with mixed lineage antigen expression in a cat

A 3-year-old neutered male British shorthair cat was presented to the Clinic for Small Animal Medicine, Internal Medicine and Clinical Pathology, at the Justus-Liebig-University Giessen with a short history of lethargy, severe dyspnoea, fever, anaemia, thrombocytopenia and hyperbilirubinaemia. In blood smears and lymph node aspirates, large pleomorphic lymphatic blasts were detected. On necropsy splenic infarcts and moderate hydrothorax as well as moderate ascites could be observed. Histological examination revealed large numbers of lymphoid blasts within the lumen of the vessels of the lung, lymph nodes, the liver, the chorioid coat of the eyes, in meningeal vessels, arteries and veins of the brain, and within the larger splenic vessels. Neoplastic cells immunohistochemically stained positive for CD45R and CD3. Based on these findings, an intravascular lymphoma was diagnosed.     

Acute pancreatitis: a newly recognised potential complication of canine babesiosis

This retrospective study describes 4 cases of canine babesiosis with histologically confirmed acute pancreatitis. In addition, 16 dogs with babesiosis are reported with serum amylase (>3500 U/l) and/or lipase (>650 U/l) activity elevations of a magnitude that would support a diagnosis of probable acute pancreatitis, although extra-pancreatic sources of the enzymes could not be excluded in these cases. Median time of pancreatitis diagnosis was 2.5 days post-admission, with primarily young (median age 3 years), sexually intact dogs affected. The development of pancreatitis was unrelated to the degree of anaemia at time of admission. In addition to pancreatitis, 80% of cases suffered from other babesial complications, namely icterus (13), acute respiratory distress syndrome (6), immune-mediated haemolytic anaemia (6), renal failure (3), haemoconcentration (2) and cerebral syndrome (2). Acute respiratory distress syndrome, renal failure and cerebral syndrome were associated with a poor prognosis, with 4 of the 5 dogs included in the overall 26% mortality rate having at least 1 of these complications. Haemolytic anaemia with ischaemia-reperfusion injury to the pancreas is proposed as a possible primary pathophysiological mechanism in babesial pancreatitis. Hypotensive shock, immune-mediated haemolytic anaemia, haemoconcentration and possibly altered lipid metabolism in babesiosis may also be involved. The previously postulated pro-inflammatory cytokine milieu of complicated babesiosis may underlie the progression, if not the primary initiation, of pancreatic pathology. Acute pancreatitis may represent the previously reported 'gut' form of babesiosis.