Medical records of 72 dogs diagnosed with immune-mediated hemolytic anemia (IMHA) were reviewed to find risk factors for the disease, for mortality, and for thromboembolism. Coagulation data of 32 patients were evaluated for mortality or thromboembolism risk factors. Cocker Spaniels were at increased risk for IMHA (P ϭ .012). Timing of vaccination was not associated with development of IMHA. PCV ranged from 5 to 33%, with a mean of 16 Ϯ 5%. Autoagglutination was present in 42% of the dogs. Platelet counts (n ϭ 60) varied from 3,000 to 793,000/L (mean, 160,117 Ϯ 133,571; median, 144,000). Thrombocytopenia (platelet count, Ͻ200,000/L) was present in 70% of the dogs, with severe thrombocytopenia (platelet count, Ͻ50,000/L) being present in 22%. One-step prothrombin time (OSPT) was prolonged in 28% of the dogs tested, and activated partial thromboplastin time (APTT) was prolonged in 47% of the dogs tested. Fibrin(ogen) degradation products (FDPs) were detected in 16 of 28 dogs tested (57%). Disseminated intravascular coagulation (DIC) was diagnosed in 10 of 31 (32%) dogs and was suspected in 8 dogs. Thromboemboli were found in 20 of 25 dogs given postmortem examinations. Mortality rate was 58%. Thrombocytopenia (P ϭ .008) and serum bilirubin concentration of Ͼ5 mg/dL (P ϭ .015) were risk factors for mortality, and hypoalbuminemia approached significance (P ϭ .053). Severe thrombocytopenia (P ϭ .046), serum bilirubin concentration of Ͼ5 mg/dL (P ϭ .038), and hypoalbuminemia (P ϭ .016) were risk factors for thromboembolism. On evaluation of continuous data, decreased platelet count (P ϭ .057), increased bilirubin (P ϭ .062), and decreased albumin (P ϭ .054) approached significance for decreased survival. A higher risk for thrombosis was found with increased alkaline phosphatase (ALKP) (P ϭ .042), increased bilirubin (P ϭ .047), and decreased albumin (P ϭ .012).Key words: Disseminated intravascular coagulation; Hypoalbuminemia; Icterus; Thrombocytopenia; Vaccination. Diagnosis of immune-mediated hemolytic anemia (IMHA) is based on identifying the combination of immune-mediated red blood cell (RBC) targeting (spherocytes, autoagglutination, and positive direct Coombs' test) with anemia and signs of hemolysis (hyperbilirubinemia, bilirubinuria, hemoglobinemia, or hemoglobinuria). IMHA can occur secondary to a variety of conditions, including systemic lupus erythematosus, neoplasia, and blood parasites, as well as administration of certain drugs. The majority of patients are considered idiopathic.IMHA continues to be a therapeutic challenge in small animal practice. Immunoglobulin or complement coating of RBCs leads to lysis or phagocytosis. Mortality up to 70% has been reported and often is associated with thromboembolism. 1 A number of retrospective studies have attempted to identify prognostic and risk factors associated with IMHA.1-6 Gender-and breed-related increased risk for IMHA has been documented in these studies. Icterus also seems to be an important risk factor for mortality in most studies.Pulmonary thromboemb...

Medical records of 72 dogs diagnosed with immune-mediated hemolytic anemia (IMHA) were reviewed to find risk factors for the disease, for mortality, and for thromboembolism. Coagulation data of 32 patients were evaluated for mortality or thromboembolism risk factors. Cocker Spaniels were at increased risk for IMHA (P = .012). Timing of vaccination was not associated with development of IMHA. PCV ranged from 5 to 33%, with a mean of 16 +/- 5%. Autoagglutination was present in 42% of the dogs. Platelet counts (n = 60) varied from 3,000 to 793,000/microL (mean, 160,117 +/- 133,571; median, 144,000). Thrombocytopenia (platelet count, <200,000/microL) was present in 70% of the dogs, with severe thrombocytopenia (platelet count, <50,000/microL) being present in 22%. One-step prothrombin time (OSPT) was prolonged in 28% of the dogs tested, and activated partial thromboplastin time (APTT) was prolonged in 47% of the dogs tested. Fibrin(ogen) degradation products (FDPs) were detected in 16 of 28 dogs tested (57%). Disseminated intravascular coagulation (DIC) was diagnosed in 10 of 31 (32%) dogs and was suspected in 8 dogs. Thromboemboli were found in 20 of 25 dogs given postmortem examinations. Mortality rate was 58%. Thrombocytopenia (P = .008) and serum bilirubin concentration of >5 mg/dL (P = .015) were risk factors for mortality, and hypoalbuminemia approached significance (P = .053). Severe thrombocytopenia (P = .046), serum bilirubin concentration of >5 mg/dL (P = .038), and hypoalbuminemia (P = .016) were risk factors for thromboembolism. On evaluation of continuous data, decreased platelet count (P = .057), increased bilirubin (P = .062), and decreased albumin (P = .054) approached significance for decreased survival. A higher risk for thrombosis was found with increased alkaline phosphatase (ALKP) (P = .042), increased bilirubin (P = .047), and decreased albumin (P = .012).

Acknowledging the limitations of cytology and the extent of discrepancies between cytologic and histopathologic findings in dogs and cats will help clinicians make better decisions in diagnosing liver disease.

BackgroundThe liver sampling technique in dogs that consistently provides samples adequate for accurate histopathologic interpretation is not known.Hypothesis/ObjectivesTo compare histopathologic results of liver samples obtained by punch, cup, and 14 gauge needle to large wedge samples collected at necropsy.AnimalsSeventy dogs undergoing necropsy.MethodsProspective study. Liver specimens were obtained from the left lateral liver lobe with an 8 mm punch, a 5 mm cup, and a 14 gauge needle. After sample acquisition, two larger tissue samples were collected near the center of the left lateral lobe to be used as a histologic standard for comparison. Histopathologic features and numbers of portal triads in each sample were recorded.ResultsThe mean number of portal triads obtained by each sampling method were 2.9 in needle samples, 3.4 in cup samples, 12 in punch samples, and 30.7 in the necropsy samples. The diagnoses in 66% of needle samples, 60% of cup samples, and 69% of punch samples were in agreement with the necropsy samples, and these proportions were not significantly different from each other. The corresponding kappa coefficients were 0.59 for needle biopsies, 0.52 for cup biopsies, and 0.62 for punch biopsies.Conclusion and Clinical ImportanceThe histopathologic interpretation of a liver sample in the dog is unlikely to vary if the liver biopsy specimen contains at least 3–12 portal triads. However, in comparison large necropsy samples, the accuracy of all tested methods was relatively low.