management tree
Hemolytic Anemia
Ann E. Hohenhaus, DVM, Diplomate ACVIM (Oncology & Internal Medicine),The Animal Medical Center, New York, New York
MINIMUM DATABASE
CBC, biochemical profile, urinalysis,
heartworm test
HEMOLYTIC ANEMIA
Elevated
bilirubin
Pigmenturia
(hemoglobinuria,
bilirubinuria)
Regenerative
anemia
Red blood cell
transfusion if
anemia is
symptomatic
Evidence of hemolytic anemia
• Review history for potential drug reactions
• Review phosphorus: If < 2.0 mg/dl, consider
hemolytic anemia secondary to low
phosphorus
• Review heartworm test: Consider
microangiopathic hemolytic anemia if
positive
Diagnosis
Treatment
Result
4 6 . . . . j a n u a r y. 2 0 0 6 . . . . . N AV C c l i n i c i a n’s b r i e f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . m a n a g e m e n t t re e
Focused diagnostic testing
Abdominal
ultrasonography
Abdominal
radiography
Splenic mass =
microangiopathic
hemolytic anemia
Metal foreign
body = zinc
toxicosis
No➞
Yes
Endoscopic
or surgical
removal
Babesia canis
titer or PCR
Ehrlichia canis
titer or PCR
Positive =
babesiosis
Positive =
ehrlichiosis
No➞
Yes
No➞
Yes
Splenectomy
and
histopathology
Imidocarb or
atovaquone
and
azithromycin
Review RBC
morphology for
Heinz bodies
and
eccentrocytes
Coombs’ Test
Positive =
Heinz body
hemolytic
anemia
Positive =
immunemediated
hemolytic
anemia
No➞
Yes
Doxycycline
No➞
Yes
Yes
Review history
for onion
ingestion,
acetaminophen,
vitamin K
Immunosuppressive
therapy
No➞
Acetylcysteine,
supportive
care
Rare causes of hemolytic anemia
•
•
•
•
Phosphofructokinase deficiency
Pyruvate kinase deficiency
Mycoplasma hemocanis
Snake bites
m a n a g e m e n t t re e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . N AV C c l i n i c i a n’s b r i e f. . . . . j a n u a r y. 2 0 0 6 . . . . . 4 7