Primary immune‐mediated haemolytic anaemia: a retrospective long‐term study in 61 dogs

Weingart, Christiane; Thielemann, D; Kohn, Barbara

doi:10.1111/avj.12875

Cited by 10 publications

(13 citation statements)

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“…Hemolysis can occur in a variety of pathological or disease conditions such as autoimmune hemolytic anemia, sickle cell anemia, thalassemia, glucose-6-phosphate dehydrogenase deficiency, exposure to certain chemicals, medicine, and toxins, blood clots, transfusion, and infection (Francis et al, 2013). Integrin α4β1/VCAM-1 interaction in hemolysis could evoke the immune response leading to corresponding cell dysfunction as shown in the present data and reported by others (Weingart et al, 2019;Dickmann and Bauer, 2020;Imataki et al, 2020;Yang et al, 2020). Therefore, exploration of innovative approaches to the therapy of immune disorders caused by hemolysis is highly demanded.…”

Section: Discussionsupporting

confidence: 79%

Integrin α4β1/VCAM-1 Interaction Evokes Dynamic Cell Aggregation Between Immune Cells and Human Lung Microvascular Endothelial Cells at Infectious Hemolysis

et al. 2021

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Bacterial and viral infection is a common cause of pneumonia, respiratory failure, and even acute respiratory distress syndrome. Increasing evidence indicates that red blood cells (RBCs) may contribute to immune response and inflammation. However, the precise molecular mechanisms that link RBC and hemolysis to the development and progression of inflammatory pathologies are not entirely understood. In this study, we used bacterial endotoxin, lipopolysaccharide (LPS), to mimic an infectious hemolysis and found that RBCs dynamically regulated cell aggregation between immune cells and human lung microvascular endothelial cells (HLMVEC). When RBCs were treated with LPS, integrin α4β1 was increased and was accompanied by cytokines and chemokines release (TNF-α, IL-1β, IL-6, IL-8, IFN-γ, CXCL12, CCL5, CCL7 and CCL4). Upon α4β1 elevation, RBCs not only facilitated mature monocyte derived dendritic cell (mo-DCs) adhesion but also promoted HLMVEC aggregation. Furthermore, co-culture of the supernatant of LPS pre-treated RBCs with mo-DCs could promote naïve CD4 T cell proliferation. Notably, the filtered culture from LPS-lysed RBCs further promoted mo-DCs migration in a concentration dependent manner. From a therapeutic perspective, cyclic peptide inhibitor of integrin α4β1 combined with methylprednisolone (α4β1/Methrol) remarkably blocked RBCs aggregation to mo-DCs, HLMVEC, or mo-DCs and HLMVEC mixture. Moreover, α4β1/Methrol dramatically reduced mo-DCs migration up-regulated glucocorticoid-induced leucine zipper in mo-DCs, and ultimately reversed immune cell dysfunction induced by hemolysis. Taken together, these results indicate that integrin α4β1 on RBCs could mediate cell-cell interaction for adaptive immunity through influencing cell adhesion, migration, and T cell proliferation.

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Section: Discussionsupporting

confidence: 79%

Integrin α4β1/VCAM-1 Interaction Evokes Dynamic Cell Aggregation Between Immune Cells and Human Lung Microvascular Endothelial Cells at Infectious Hemolysis

et al. 2021

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“…O tratamento da AHIM consiste em cuidados de suporte e terapia com imunossupressores com corticosteroides, a fim de que haja depressão do sistema imune e não haja resposta contra os eritrócitos [6]. Inicialmente, foi suspendido o cloridrato de tramadol, dipirona e amoxicilina com clavulanato de potássio, com intuito de interromper a causa da AHIM, e foi iniciada a administração de dexametasona em dose imunossupressora.…”

Section: Discussionunclassified

“…Inicialmente, foi suspendido o cloridrato de tramadol, dipirona e amoxicilina com clavulanato de potássio, com intuito de interromper a causa da AHIM, e foi iniciada a administração de dexametasona em dose imunossupressora. Posteriormente, o animal começou a apresentar efeitos adversos, como poliúria, polidipsia, taquipneia e diarreia, bem como descrito na literatura como sinais colaterais a terapia com dexametasona [5,6].…”

Section: Discussionunclassified

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Immune-Mediated Hemolytic Anemia in a Bitch Triggered by Drugs

Martins

Ledur

Queiroga

et al. 2021

Acta Scientiae. Vet.

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Background: Immune-mediated hemolytic anemia (IMHA) is characterized by an autoimmune response with production of auto-antibodies and destruction of erythrocytes resulting in anemia. Primary IMHA is referred to a condition when the cause is unknown (idiopathic), whereas secondary IMHA involves changes in red blood cells caused by the action of drugs, neoplasms, or infectious diseases. The diagnosis can be made through changes in the blood count, usually of a regenerative character, Coombs test, and autoagglutination test. The present study aimed to report a case of drug-induced hemolytic anemia, with emphasis on the clinical signs, diagnostic methods, and treatment, in a female dog.Case: A 9-year-old mixed-breed bitch weighing 29.6 kg was referred to the Veterinary Medical Teaching Hospital (HCV-UFRGS) with a previous diagnosis of gallbladder mucocele that was unresponsive to clinical treatment. After laboratory tests, cholecystectomy was performed, and the procedure required conversion from laparoscopic to open cholecystectomy. Therapy included administration of amoxicillin, dipyrone, tramadol hydrochloride, and meloxicam. Three days after surgery, the dog presented with apathy, lethargy, hyporexia, and a pale and subicteric mucosa. The patient developed hypochromic macrocytic anemia with reticulocytosis, spherocytosis, anisocytosis, and leukocytosis with neutrophilia. The result of the autoagglutination test was positive, confirming the diagnosis. All medications were suspended, and immunosuppressive treatment with dexamethasone was included, with a subsequent switch to prednisolone. After 10 days of treatment, the patient experienced significant improvement, and therapy was discontinued.Discussion: Based on the patient's history, the cause of the IMHA was secondary to drug administration, and it is not possible to distinguish if it was due to one or a combination of drugs, as they were all started and stopped simultaneously. The patient had hypothyroidism, which may have contributed to the production of antibodies against TSH receptors, blocking the hormone's action, thereby causing tissue damage due to T cell-mediated cytotoxicity and the effect of cytokines. The pale and subicteric mucosa, apathy, weakness, lethargy, exercise intolerance, and dyspnea resulted from extravascular hemolysis and bilirubin released from erythrocyte rupture with a subsequent decrease in the number of red blood cells, leading to oxygen transport deficiency. The diagnosis is based on the blood count and results of autoagglutination supported by the response to immunosuppressive therapy. Anemia results in increased production and release of precursor cells from the bone marrow, accompanied by reticulocytosis and increased mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC). The treatment of IMHA consists of supportive care and immunosuppressive therapy with corticosteroids to ensure suppression of the immune system, preventing response against erythrocytes. Initially, tramadol hydrochloride, dipyrone, and amoxicillin with potassium clavulanate were suspended to interrupt the cause of IMHA, and administration of dexamethasone in an immunosuppressive dose was started. Therefore, it is important to include drug-induced IMHA in the differential diagnosis of patients who present with anemia after using medications. Early diagnosis, initiation of therapy, and adequate care were important factors for the recovery of the animal.Título: Anemia hemolítica imunomediada medicamentosa em uma cadelaKeywords: dog, hypochromic macrocytic anemia, erythrocyte, hemoglobin, spherocyte.Descritores: cão, anemia macrocítica hipocrômica, eritrócito, hemoglobina, esferócito.

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“…

Immune-mediated hemolytic anemia (IMHA) characterized by activation of the complement system and production of autoantibodies resulting in erythrocyte destruction is one of the most common hematological problems among dogs (7,23). IMHA diagnosis is a rule-out diagnosis.

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mentioning

confidence: 99%

Cerebral hemorrhage in a dog with immune-mediated hemolytic anemia and concurrent thrombocytopenia – a case report

Çolakoğlu¹,

Haydardedeoğlu²,

Alihosseini³

et al. 2021

Medycyna Weterynaryjna

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The aim of this case report is to point out the neurological signs, long term management of the case and MRI lesions suggestive of cerebral haemorrhage in a dog with IMHA and concurrent thrombocytopenia. A 3.5-year-old intact female Cocker Spaniel dog was examined for anorexia, weakness, exercise intolerance and two collapse episodes. Based on the diagnostic procedures primary immune mediated hemolytic anaemia concurrent with severe thrombocytopenia were confirmed. The dog remained stable with prednisolone and fluid therapy for 6 weeks. The dog was later referred to emergency service with hemianopia, head tilt and epilepsy-like signs. Brain MRI lesions showed central line deviation, oedema and cerebral haemorrhage. Post-treatment MRI also provided clear evidence of resolution the cerebral haemorrhage. The dog was asymptomatic for 6 months after splenectomy. To the best our knowledge, this is the first fully documented report of cerebral haemorrhage in a dog with immune mediated hemolytic anaemia and thrombocytopenia.

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Primary immune‐mediated haemolytic anaemia: a retrospective long‐term study in 61 dogs

Cited by 10 publications

References 35 publications

Integrin α4β1/VCAM-1 Interaction Evokes Dynamic Cell Aggregation Between Immune Cells and Human Lung Microvascular Endothelial Cells at Infectious Hemolysis

Integrin α4β1/VCAM-1 Interaction Evokes Dynamic Cell Aggregation Between Immune Cells and Human Lung Microvascular Endothelial Cells at Infectious Hemolysis

Immune-Mediated Hemolytic Anemia in a Bitch Triggered by Drugs

Cerebral hemorrhage in a dog with immune-mediated hemolytic anemia and concurrent thrombocytopenia – a case report

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