Primary Immune-mediated Hemolytic Anemia in 19 Cats: Diagnosis, therapy, and Outcome (1998–2004)

Abstract

Immune-mediated hemolytic anemia (IMHA) occurs less frequently in cats than in dogs. The value of the Coombs' test (CT) has been questioned, but detailed surveys of its use are lacking. The objective of this study was to describe 19 cats with primary IMHA (pIMHA) and to examine the diagnostic value of the direct CT. The CT was performed in 92 cats; it was negative in 5 healthy, in 9 sick nonanemic, and in 55 cats with different types of anemia. The CT was positive in 18 anemic cats (2 feline leukemia virus (FeLV) positive, 1 with cholangiohepatitis, 15 with no underlying disease). Moreover, agglutination persisted after saline washing in 5 anemic cats (1 lymphoma, 4 pIMHA). Inclusion criteria for pIMHA were a positive CT (15) or persistent agglutination (4), and the exclusion of other diseases. The age of the 19 cats ranged from 0.5 to 9 years (median, 2 years); male cats were overrepresented. The PCV on admission was 6-22% (median, 12%). The anemia was nonregenerative in 11 cats. Additional abnormal laboratory results were leukocytosis (2), lymphocytosis (6), hyperbilirubinemia (13), hyperglobulimemia (10), and increased liver enzyme activities (10). Initial treatment consisted of blood transfusions (10), crystalloids (11), prednisolone (19), antibiotics (19), and H2-blockers (11). Four of 17 cats were euthanized 9, 63, 240 and 2,160 days after initial presentation (mortality rate, 23.5%). Relapses were reported in 5 of 16 cases (31%). Thus, pIMHA appears to occur more frequently than recognized previously, with a more favorable prognosis in cats than in dogs. The CT was useful in identifying immune-mediated pathogenesis.

A retrospective study of 180 anaemic cats: features, aetiologies and survival data

“…An association between pica and immunemediated disease has been described previously when 25% of cats with primary IMHA had pica. 2 Jaundice was found in 16.7% of cats and was not always associated with haemolysis; only nine (5%) cats had both jaundice and evidence of haemolysis in the current study. Haemolysis alone rarely causes jaundice (only 10% cats with primary IMHA were jaundiced in a previous study 2 ) owing to the large reserve capacity of the liver, although severe anaemia may cause jaundice due to hypoxic liver damage, impaired liver function and intrahepatic cholestasis.…”

A Novel and Likely Inherited Lymphoproliferative Disease in British Shorthair Kittens

“…It is also possible that the disease may not have responded to prednisone treatment because the dose administered was at the low end of that recommended in cats. 13 A higher prednisone dose rate or an alternative immunosuppressive drug, such as mycophenolate mofetil, 2 may have more successfully managed the clinical signs of disease in these kittens. However, it is also possible that treatment was unsuccessful due to the absence of any immune-mediated basis for disease development in these kittens.…”

Detection of Anaplasma phagocytophilum in a cat

“…Symptoms and haematological disorders similar to those observed in the described cat may also develop in the course of diseases such as haemotropic mycoplasmosis (Sykes 2010) or immune mediated haemolytic anaemia (IMHA) (Kohn et al 2006). Both diseases should be considered in the differential diagnosis of anaplasmosis.…”