Dal‐induced red blood cell incompatibilities in a Doberman Pinscher with von Willebrand factor deficiency and ehrlichiosis

Abstract

Objective To describe a complex case involving the management of a dog with von Willebrand disease (vWD), active ehrlichiosis infection, nonregenerative anemia, and blood type incompatibility related to the Dal antigen. Case Summary A 13‐week‐oldintact male Doberman Pinscher weighing 7.2 kg was presented to the emergency service for a previous hemorrhaging event and progressive nonregenerative anemia. The dog had received a fresh whole blood transfusion 8 days prior to presentation due to severe anemia. Upon presentation, the puppy was tachycardic, and his mucous membranes were pale. A CBC revealed a nonregenerative anemia with a PCV of 0.11 L/L (11%). von Willebrand factor deficiency was suspected and later confirmed. The dog's blood type was dog erythrocyte antigen (DEA) 1 positive, but cross‐matching to 4 RBC units, both DEA 1 positive and negative, failed to yield any compatible units. Antibody against a possible Dal RBC antigen was suspected, and 11 blood donors (Dalmatians and Dobermans) were cross‐matched to find 2 compatible donors. After an uneventful fresh whole blood transfusion, a bone marrow biopsy revealed a hypocellular bone marrow and erythroid hypoplasia. A SNAP4DxPlus test and subsequent polymerase chain reaction (PCR) testing were positive for Ehrlichia ewingii and E. canis. Treatment with doxycycline was started, and the PCV was 0.17 L/L (17%) at discharge. At the 1‐week follow‐up, the PCV was 0.24 L/L (24%), and the puppy was doing well. New or Unique Information Provided This is a unique case of a dog presenting with several challenging disorders, including vWD resulting in hemorrhage, ehrlichiosis potentially contributing to a nonregenerative anemia, and a blood type incompatibility due to the Dal antigen. Doberman Pinschers have a high prevalence of vWD‐ and Dal‐negative phenotype, which emphasizes the value of cross‐matching and the recognition of antigen prevalence in specific breeds.

Validation of a cage‐side agglutination card for Dal blood typing in dogs

“… 6 , 8 , 10 Cases of incompatible major crossmatch after a first transfusion have been reported secondary to the Dal blood group, including 1 Dalmatian upon its discovery in 2007. 3 , 11 In vitro, Dal‐related incompatibilities are associated with strong agglutination reactions on the gel column ranging from 3+ to 4 + . 3 , 5 , 6 Moreover, the Dal antigen is extremely immunogenic, with anti‐Dal antibodies present as early as 4 days after transfusion and persisting until 2 years later.…”

“…Although the cage‐side card agglutination test has excellent sensitivity (92.5%‐97.6%) and specificity (96.6%‐100%) for Dal blood typing in healthy individuals, the scarcity of Dal‐negative blood may make it challenging to arrange a compatible Dal‐negative transfusion under emergency conditions. 3 , 11 The blood typing cards may become a rapid option for screening for Dal‐negative individuals, especially in some of the breeds mentioned above that could then become candidates for blood banking. Conversely, in a clinical setting, preventive detection of Dal‐negative individuals would increase vigilance in the management of these patients, particularly in certain breeds such as Doberman Pinschers which are at higher risk of bleeding because of their predisposition to Von Willebrand disease.…”

“…Acute hemolytic transfusion reactions and incompatible crossmatches have been reported clinically in previously transfused dogs receiving a transfusion ≥4 days after a first transfusion 6,8,10 . Cases of incompatible major crossmatch after a first transfusion have been reported secondary to the Dal blood group, including 1 Dalmatian upon its discovery in 2007 3,11 . In vitro, Dal‐related incompatibilities are associated with strong agglutination reactions on the gel column ranging from 3+ to 4 + 3,5,6 .…”

“…Ideally, even a first transfusion in a Dal‐negative patient should be done using compatible Dal‐negative blood (and DEA 1‐matched) to avoid sensitization and hemolytic transfusion reaction with subsequent transfusions. Although the cage‐side card agglutination test has excellent sensitivity (92.5%‐97.6%) and specificity (96.6%‐100%) for Dal blood typing in healthy individuals, the scarcity of Dal‐negative blood may make it challenging to arrange a compatible Dal‐negative transfusion under emergency conditions 3,11 . The blood typing cards may become a rapid option for screening for Dal‐negative individuals, especially in some of the breeds mentioned above that could then become candidates for blood banking.…”

Evaluation of post-transfusion RBC alloimmunization in dogs using a gel-column crossmatch with and without anti-canine globulin enhancement

“… 13 Although there is controversy regarding the need for a blood crossmatch for transfusion-naïve dogs given their lack of clinically significant naturally occurring RBC alloantibodies, there is a consensus that a blood crossmatch is indicated for dogs that received RBCs ≥4 d earlier. 6 , 7 , 11 , 13 , 18 , 20 , 26 The need for, or potential benefit of, an anti-canine globulin (ACG)-enhanced crossmatch has not been clearly established in veterinary medicine.…”