Autoimmune hemolytic anemia. Clinical blood test - Veterinary nephrology clinic VeraVet. Veterinarian at home

Anemia is not a disease, but rather a symptom oh someone else pathological process or illness. Anemia is medical term, characterizing a decrease in the number of circulating red blood cells, hemoglobin, or both. Hemoglobin carries oxygen to the body's tissues and cells, and a patient who has anemia will suffer from symptoms associated with a lack of oxygen.

Red blood cells are primarily produced in the bone marrow and then released into the bloodstream. When these cells age or become damaged, they are removed from the blood and recycled to form new ones. The number of red blood cells in the blood may decrease if their production in the bone marrow decreases or if there is an increased loss of them in the general bloodstream.

What is autoimmune hemolytic anemia?

Autoimmune means an immune reaction directed against oneself, and the word hemolysis comes from the Greek words hemo and lys, meaning blood and to break, respectively. Autoimmune hemolytic anemia(AGA) is a disease immune system when it destroys its own red blood cells. In dogs with AGA, red blood cells continue to be produced in the bone marrow, but once they enter the bloodstream, they have a shorter than normal lifespan.

This disease may also be called immune-mediated hemolytic anemia.

What are the causes of autoimmune hemolytic anemia?

AGA can be idiopathic or symptomatic (secondary).

In dogs with idiopathic AGA, the immune system does not work properly and produces antibodies that target its red blood cells. By different estimates Idiopathic AGA in dogs accounts for approximately three-quarters of all cases of AGA.

Red blood cells can be destroyed in blood vessels through a process called intravascular hemolysis, or by passing through the liver or spleen through a process called extravascular hemolysis. During both processes, hemoglobin levels will decrease, which will increase the load on the liver.

What are the symptoms of autoimmune hemolytic anemia?

Most dogs with AGA develop severe anemia and their gums become very pale. Dogs with anemia become lethargic and tire quickly, this occurs because there is a lack of red blood cells in the blood, which carry oxygen to the tissues. The dog may faint or become disoriented due to low level oxygen in the brain. To compensate for the lack of oxygen in the tissues, the heart begins to beat faster and the dog will breathe more quickly.

As the disease progresses, the body will accumulate high levels of bilirubin, a breakdown product of red blood cells through hemolysis. Some bilirubin will be excreted in the urine, causing it to turn dark. High levels bilirubin makes the skin, gums and other mucous membranes yellow, i.e. cause jaundice. The dog may vomit and have a severe decrease in appetite.

How is AGA diagnosed?

Anemia is diagnosed using an extensive blood test. In the case of AGA, the number and percentage red blood cells will be low, and the size and shape of the cells will be abnormal. In many cases of AGA, autoagglutination, or abnormal clumping of red blood cells, occurs.

If AGA is detected, the veterinarian may also recommend additional diagnostic tests to determine whether the disease is primary or secondary.

Treatment of autoimmune hemolytic anemia

If your dog's anemia is so severe that it is life-threatening, he will require a blood transfusion. Before the transfusion, a blood sample must be taken for analysis. The main purpose of blood transfusion is to stabilize the dog's condition, the root cause of the anemia must be diagnosed through tests and then an appropriate course of treatment must be taken.

If AGA is secondary, or symptomatic, then treatment should be directed to the underlying cause. If the underlying cause cannot be determined, or the disease is diagnosed as idiopathic, immunosuppressive therapy will be prescribed. In some cases of idiopathic AGA, the dog responds well to immunosuppressive doses of corticosteroids. In other cases, the patient may require a combination of immunosuppressive drugs.

Your veterinarian will use the test results to outline a treatment plan that best suits your dog's needs. IN difficult cases, your veterinarian may recommend a referral to a conventional medicine specialist.

Prognosis for treatment of autoimmune hemolytic anemia

Treatment prognosis for dogs with AGA depends on the specific diagnosis as well as general condition patient. In many cases the disease can be controlled with drug treatment. Once the dog's condition is stabilized, the anemia usually resolves and the veterinarian may recommend reducing the dosage of immunosuppressive medications over several months to reduce any side effects. AGA is prone to relapse, so you will need to monitor your dog more closely after medications are reduced or discontinued.

Autoimmune hemolytic anemia is an extremely serious disease in humans and animals, characterized by autoimmune mechanisms aimed at destroying body cells, in particular, normal red blood cells. In 60-70% of cases, etiology of this disease remains unidentified.

The disease is widespread, observed everywhere. Autoimmune hemolytic anemia has been reported in dogs of all breeds. However, Cocker Spaniels, Poodles, Old English Sheepdogs and Irish Setters are more likely to have it. Also, a number of researchers note that most often this pathology occurs in young females and middle-aged females. No pronounced seasonality has been established.

Causes

The main reason for the occurrence of autoimmune hemolytic anemia, according to many researchers, is the genetic predisposition of the individual. Other factors contributing to the occurrence of the above pathology include transferred by a dog infectious diseases(mycoplasmas, viruses of the Paramyxoviridae family), iatrogenic effects on the body (fludarabine, interferon alpha), oncological lesions (leukemia, lymphoma), vascular autoimmune diseases.

Pathogenesis

Pathogenesis of autoimmune hemolytic anemia, regardless of etiological factor appears as follows. Under the influence of the above pathogenic endogenous or exogenous factors on the body, sensitization of red blood cells occurs with a change in their surface antigenic structure, which, in turn, leads to a violation of the histocompatibility complex in the body and impaired tolerance to cells own body. As a result of these ongoing processes, the individual’s body begins to produce specific autoimmune antibodies directed against its own previously normal sensitized red blood cells. As a result of the usual immune reaction - antigen (normal sensitized erythrocyte) + complement + autoantibody - the erythrocyte is damaged with a change in its normal shape, volume and transformation into a spherocyte. Red blood cells transformed into spherocytes are recognized by macrophages of the spleen, liver, bone marrow as foreign cells that pose a danger to the body and are destroyed through hemolysis. As a result of massive intravasal and extravascular hemolysis of erythrocytes in the bloodstream, the amount of free hemoglobin, which is unable to be metabolized into bilirubin, sharply increases.

At the same time, according to J. Pellerin, C. Fournel, L. Chaban, primary autoimmune hemolytic anemia, caused by the action of autoimmune immunoglobulins class G, is more common in dogs. Secondary autoimmune hemolytic anemia is often combined with systemic lupus erythematosus and autoimmune dermatosis.

Another consequence of extensive hemolysis is the accumulation of free bilirubin in the blood, which, due to liver dysfunction, cannot be associated with glucuronic acid and thereby be neutralized.

As a result of the described processes, on the one hand, loss of hemoglobin in the urine occurs, and on the other hand, unbound bilirubin has a toxic effect on the central nervous system, kidneys, and organs endocrine system, liver, heart, etc. In addition, the fact of destruction of the red blood cell, which is shaped element blood, responsible for the transport of oxygen to the cells of organs and tissues of the body, leads to the development of anemia, hypoxia and other disorders.

Symptoms

The clinical manifestation of autoimmune hemolytic anemia does not have pronounced symptoms inherent specifically to this disease. The main symptoms that accompany anemia in dogs and that can be recognized are:

Change in color of the animal's urine to dark brown;

Paleness and/or yellowness of the mucous membranes;

Physical inactivity of the animal;

Muscle pain;

Vomiting in a dog;

Change in color of feces to black (sometimes);

Anorexia;

Progressive weakness;

Rapid heartbeat (tachycardia);

Increased body temperature;

Significant enlargement of the spleen and peripheral lymph nodes.

Diagnostics

Diagnosis of autoimmune hemolytic anemia is complex and should include an analysis of the medical history, clinical examination of the animal, laboratory and diagnostic methods research.

For staging clinical diagnosis V.N. Mitin proposed the following summary algorithm of symptom complexes:

1. Abnormal size of retinal vessels;

2. Anorexia - lack of appetite, refusal to eat;

3. Tachycardia;

4. Pallor of visible mucous membranes;

5. Fast fatiguability during physical activity;

6. Hemorrhagic diathesis, blood clotting disorder;

7. Generalized weakness;

8. Hepatosplenomegaly, splenomegaly, hepatomegaly;

9. Hypodipsia, adipsia;

10. Hyphema - blood in the anterior eye chamber, “black eye”;

11. Diarrhea, diarrhea;

12. Dehydration;

13. Dyspnea - difficulty breathing with an open mouth;

14. Jaundice;

15. Presence of blood in feces;

16. Fever, pathological hyperthermia;

17. Black feces;

18. Petechiae, ecchymoses;

19. Polydipsia - increased thirst;

20. Polyuria - increased volume of urination;

21. Reduced reception water;

22. Vomiting, regurgitation, emesis;

23. Heart murmurs;

24. Polypnea, tachypnea, hyperpnea - increased frequency of respiratory movements;

25.Lymphadenopathy – enlargement of the spleen and peripheral lymph nodes;

26. Depressed state of the dog;

27. Hematuria, hemoglobinuria;

28. Dog urine is red or brown;

29. Rhinorrhagia - discharge of blood from the nose.

When conducting laboratory research carry out full analysis blood, urine, feces. At the same time, the presence of spherocytes is detected in the blood, a decrease in the number of red blood cells to 1-2 million, which indicates severe anemia; polychromasia and reticulocytosis; change in the level of hemoglobin in the blood (below 110 g/l); high concentration bilirubin in blood serum - above 19 µmol/l. When analyzing urine, a change in the color of urine from red to brown is detected due to hemoglobinuria and urobilinogenuria. A stool examination reveals the release of stercobilin in feces.

As a laboratory diagnostic test When determining autoimmune hemolytic anemia, the direct Coombs test is used. It is used to determine the level of nonspecific immunoglobulins and autoantibodies in the blood serum.

Another technique in diagnosing autoimmune hemolytic anemia is a steroid test. Positive response of the body to the use of prednisolone with therapeutic purpose can serve as an indicator confirming the correctness of the assumption about the above disease.

The main complication of the above disease is the development of thromboembolism. The prognosis for autoimmune hemolytic anemia ranges from cautious to unfavorable.

Differential diagnosis of autoimmune hemolytic anemia in dogs should be carried out from other types of anemia, as well as diseases that occur with a clinically similar picture - hepatitis of different nature, leptospirosis, listeriosis, etc.

Treatment

The direction of treatment of autoimmune hemolytic anemia in dogs is determined by the pathogenesis of the disease. In this regard, if etiological cause the pathologies described are infectious diseases or neoplasms in the body, then first of all veterinarian is working to eliminate them. Eliminating the underlying causes will help speedy recovery sick animal.

In the case of iatrogenic nature of autoimmune hemolytic anemia, it is necessary to stop receiving medicines into the body.

With the development of autoimmune hemolytic anemia due to genetic predisposition of the individual's body, treatment is aimed at the use of immunosuppressants, for example, sandimmune (cyclosporine A), azathioprine, cyclophosphamide, rituximab. Also, corticosteroids such as prednisone, prednisolone, methylprednisolone, dexamethasone or betamethasone can act as substances that suppress the body's immune activity. These drugs, by suppressing immunological reactions, significantly improve the patient's condition and prevent the development of hemolysis.

A radical method in the fight against autoimmune hemolytic anemia is surgical removal spleen. Splenectomy, on the one hand, avoids relapses of the disease, and, on the other hand, removal of the immunocompetent organ will reduce the level of hemolysis.

Moreover, in all cases of autoimmune hemolytic anemia, treatment should include detoxification of the body, administration of iron-containing drugs, vitamins, for example, cyanocobalamin (vitamin B12), which promotes erythropoiesis.

Veterinary center "DobroVet"

Probably every dog ​​owner has sometimes noticed that his beloved pet for some reason refuses or gets tired of the usual physical activity. If this passes quickly, then this state of the animal does not cause any particular concern. But if this is repeated very often or becomes a constant occurrence, then some suspicions arise about the pet’s health. Often the cause of this phenomenon can be a disease such as anemia.

What is anemia

Anemia can affect both people and animals. Cause of the disease- decrease in red blood cells in the blood. Red blood cells are cells that provide the body with oxygen. Their deficiency worsens the condition of all systems and organs of the animal.

Anemia can affect dogs of any breed and at any age. With this disease, blood mass can remain normal, decrease, or even increase. The increase may occur due to the fact that the lack of liquid component of the blood is replenished tissue fluid. At the same time, there are qualitative changes in the blood. The reason for this is the low hemoglobin content in red blood cells.

Anemia is also popularly called anemia. It's pretty dangerous disease in dogs. It often occurs like independent disease, and sometimes it is a symptom of other serious illnesses. Anemia must be noticed and diagnosed in time, otherwise it can lead to the death of the animal. To do this right away, you need to know the symptoms of the disease and its causes.

Anemia is extremely diverse and is often hidden under the signs of other diseases, but nevertheless we can identify its general symptoms.

Red blood cells carry oxygen to all organs and tissues of the body, which is very important for the life of the animal. If the level of red blood cells decreases, the dog becomes lethargic and gets tired very quickly from physical activity. Her activity decreases, she wants to lie down more often, and sometimes gets up only to relieve herself.

Pets' appetite decreases, sometimes so much that they refuse to eat at all. Another clear sign of anemia is the paleness and even blueness of the mucous membranes of the animal, the gums become cold to the touch.

And also other quite severe symptoms anemia:

• disturbances in the gastrointestinal tract - loose stool, vomit;
• dyspnea;
• feverish condition;
• polydipsia - the animal begins to drink water intensively;
• polyuria - the amount of urine excreted increases, but this does not always happen.

During the examination, veterinarians may detect other malfunctions in the body: jaundice, rapid breathing, tachycardia, systolic murmurs. Bilirubin or hemoglobin may color urine Brown color. At ultrasound examinations Enlargement of the lymph nodes, liver and spleen can be detected.

Contact a veterinary hospital as soon as you suspect anemia in your dog.

Very often the cause of anemia in an animal is big loss blood due to serious injury or caused by illness or severe inflammation in the gastrointestinal tract.

The disease can be caused by infectious diseases caused by ticks. This happens more often in small breed dogs.

The disease can also be provoked by an immune-mediated disease, due to which one’s own red blood cells are destroyed.

Internal bleeding, and then anemia, can be caused by the use of certain medications, for example, non-steroidal anti-inflammatory drugs.

Flea infestation is no less dangerous than tick infestation. This is especially true for young animals and small breed dogs.

Poisoning caused by ingestion heavy metals or potent poisons, which causes intoxication of the body, can ultimately also lead to anemia. This is a very dangerous species; it can develop very quickly, and sometimes simply at lightning speed. A disease in which under the influence of hemolytic poisons(mercury, arsenic, lead, insect poisons, snakes, ammonia) increased destruction of red blood cells occurs, called hemolytic anemia.

Both external and internal bleeding occur in cases of cancer.

Formation blood cells may be suspended medical supplies, which are used in the treatment of chronic diseases such as cancer or renal failure.

General diagnostic principles

It should be noted that anemia is not difficult to diagnose. It is more difficult to determine the disease that caused anemia, because it is only a symptom of some other disease.

After the dog gets to the veterinary clinic, it is done general analysis blood and urine. This makes it possible to determine whether the animal has anemia and, if it is present, then doctors then begin to search for the disease that caused it.

When a dog is diagnosed with anemia, but the reason why the red blood cells are destroyed is unknown, then a blood smear is taken and examined under a microscope. In case of blood loss for unknown reasons A stool examination is performed to determine if there is hidden blood.

In some cases, when it is difficult to determine the underlying disease, the diagnosis must be carried out in more detail. If there is a suspicion of pathology in the production of red blood cells, then a bone marrow biopsy is performed. Sometimes from abdominal cavity A sample of free fluid is taken, this method helps detect free blood.

Thanks to these research methods, it becomes possible to detect anemia in dogs.

Treatment

After diagnosing anemia in an animal, which shows whether it is a separate phenomenon or a symptom of another dangerous disease, you should immediately begin treatment for the disease. It will depend on the severity of the pet's condition. Treatment can include both medications and surgery.

If the disease progresses to severe form and already threatens the life of the animal, then in this case a blood transfusion is given. This helps stabilize the dog's condition. Appropriate treatment should also be prescribed.

Therapy depends on what disease caused the anemia. As a rule, the veterinarian, when prescribing treatment, looks at the condition of the dog and its age.

When treating anemia, the following procedures are performed:

If other methods are ineffective, then surgery is performed.

During the treatment period, it is necessary to constantly monitor the pet's health.

Treatment prognosis

How quickly a dog copes with anemia depends on the pet’s health status at this moment and what caused this disease.

If treatment was started on time, then after 3-4 weeks the symptoms of the disease stop. But when the disease turns into chronic form, then therapy may be delayed. Even after the dog will be complete course of treatment, she is still for a long time will return to normal.

The speed of recovery also depends on the age of the animal. Young dogs recover faster, in about 16-23 days.

Prevention of anemia in dogs

It is impossible to completely insure against this disease. But if the owner takes care of his pet, give him proper food, walk with him, take him for examination to specialists on time, treat him, carry out the necessary vaccinations, this will help avoid serious diseases that lead to anemia.

Attention, TODAY only!

Anemia is a medical term that describes the condition of a decrease in the number of circulating red blood cells or hemoglobin in the blood. It is not a disease, but rather a symptom of some other process, disease or disorder. Hemoglobin carries vital oxygen to the body's tissues and cells, and an animal that suffers from anemia will suffer from symptoms associated with a lack of oxygen.

Red blood cells are produced in the bone marrow and then released into the blood, where they live for about two months. As they age or become damaged, they are filtered out of the blood and their components re-form into new red blood cells. The number of red blood cells may decrease due to decreased production or increased loss.

Symptoms of anemia

The main obvious clinical symptom anemia in dogs, as in cats, are pale or pale pink gums. Anemic dogs also have low stamina and get tired very quickly. Pale gums and general lethargy indicate the need for a blood test.

Diagnostics

Anemia is diagnosed through a blood test. The most common is to determine the hematocrit level. This test is performed as part of an advanced blood test. If the hematocrit level is 35% below normal, the dog will be diagnosed with anemia.

There are many diseases that can cause anemia. They are divided into three groups: 1) diseases that cause blood loss, 2) diseases that cause hemolysis (breakdown and destruction of red blood cells), and 3) diseases that suppress the production of red blood cells in the bone marrow.

Diseases that cause blood loss

The main causes of blood loss in dogs are:

The main causes of bone marrow suppression, which results in decreased red blood cell production, are:

• Severe or chronic illness (such as kidney failure or liver disease)
• Very poor nutrition or imbalance nutrients
• Autoimmune diseases
• Hypothyroidism
• Poisoning by chemicals or toxins
• Neoplasia (tumor)

Iron deficiency anemia in dogs

Iron deficiency anemia is a fairly common disease in humans. But iron deficiency is rare in dogs and usually develops due to chronic blood loss or a very poor diet.

Treatment of anemia

If a dog's anemia has become so severe that it is life-threatening, it will require a blood transfusion. The purpose of the transfusion is to stabilize the dog, but the root cause of the anemia must be diagnosed and an appropriate treatment program instituted.

Treatment of anemia depends on the diagnosis and severity of the animal's condition. Treatment may include corticosteroids, diet therapy, other medications, and surgery.

Prognosis for Dogs with Anemia

The prognosis for dogs suffering from anemia depends on the specific diagnosis and the overall health of the animal at the time of diagnosis. At timely diagnosis anemia and good condition the dog's health, the prognosis is favorable. Dogs who suffer from chemical poisoning, cancer or autoimmune diseases, have a less favorable prognosis.

With anemia, the level of hemoglobin, which is needed to supply cells and tissues with oxygen, decreases, and the number of red blood cells also decreases as a result heavy blood loss or the destruction of red blood cells in the body by disease.

All dogs are susceptible to anemia, regardless of age and gender, but some animals are in the increased risk, in particular dogs prone to infectious and gastrointestinal diseases.

Causes of anemia in dogs

There are many causes of anemia, but one of the most common is blood loss due to severe trauma.

Anemia in dogs occurs due to infectious and other serious illnesses, for example, with piroplasmosis, hepatosis, cancer, chronic disease kidney, liver, tumors gastrointestinal tract, Bladder and spleen, diseases that prevent normal blood clotting.

Autoimmune hemolytic anemia is hereditary and develops with a deficiency of the enzyme pyruvate kinase (more common in Basenjis and Beagles) or a deficiency of the enzyme phosphorus-ructokinase. Hereditary anemia is rare. The second form of this type of anemia is when the body's immune system attacks its own red blood cells, destroying them.

In case of poisoning chemicals, medicines Some dogs develop anemia. There are cases when an animal experienced anemia when treated with medications that interfere with the production of red blood cells.

The cause may also be insufficiency of hematopoiesis, lack of vitamin B12, copper, iron, folic acid. It can be congenital or acquired. Iron deficiency is rare in dogs and is often secondary symptom anemia as a result of excessive blood loss.

Large numbers of worms, fleas or ticks can cause anemia in puppies and small dogs.

Symptoms

At mild form With anemia, the symptoms of the disease are difficult to notice and often require a blood test to determine the percentage of red blood cells and confirm the diagnosis. Anemia develops against the background of another disease, so even if you have symptoms, determine it yourself the real reason difficult.

Due to low hemoglobin levels, oxygen starvation cells, resulting in symptoms of anemia such as lethargy and decreased activity.

The primary sign of anemia is pallor of the oral mucosa, in particular the gums, which become pale pink or almost white. Pale gums and flaccidity are good reasons for a blood test.

Other symptoms of anemia are rapid pulse, difficulty breathing, decreased appetite, and with hemolytic anemia, jaundice appears.

Treatment of anemia in dogs

The diagnosis is made based on the results of blood and bone marrow tests. The method of treatment depends on the cause of anemia.

The introduction of hemostatic agents and blood transfusions are carried out in case of severe external or internal bleeding.

If the cause of anemia is poisoning, then the animal is administered glucocorticoids and detoxifying agents, multivitamins, corticosteroids, depending on the cause of poisoning.

Replenishing the lack of vitamins and restoring the balance of nutrients is carried out by introducing vitamin B12, folic acid, and iron substance. Products with high content iron, vitamin B, for example, raw beef liver, spleen. You can mix up to 2 teaspoons of finely chopped barley or wheat (or wheat, barley juice, powder) into food. The chlorophyll contained in these plants helps produce blood cells.

Autoimmune anemia in dogs is treated with drugs that suppress the activity of the immune system. But treatment is not always effective due to frequent relapses, which lead to the death of the animal.

Hemoglobin can be increased, but it is not always possible to cure anemia, it all depends on the cause of anemia. For example, by eliminating fleas and worms and ensuring proper nutrition, you can restore the dog’s health, but if the cause is intractable infectious diseases, then the chances of recovery are reduced.

Prevention

Universal preventive measures does not exist, because the causes of anemia are different and it is impossible to protect your pet from all dangers. But you can reduce the risk of developing anemia if you provide the animal with proper care, including proper feeding, regular examination, visits to the veterinarian, vaccination, and thereby protect him from the development of diseases that contribute to anemia.

When treating diseases, it is important to do frequent blood tests to identify negative reaction the body to the administered drugs, and in case of blood loss, a well-designed treatment plan is important.