Monday, February 4, 2013

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

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

  1. Barbara Kohn1,*
  2. Christiane Weingart1,
  3. Vera Eckmann1
  4. Mareike Ottenjann1,
  5. Wolfgang Leibold2
Article first published online: 28 JUN 2008
DOI: 10.1111/j.1939-1676.2006.tb02836.x
Journal of Veterinary Internal Medicine

Journal of Veterinary Internal Medicine

Volume 20Issue 1pages 159–166January 2006


  • Coombsyy;
  • test;
  • Course of disease;
  • Feline hemolytic anemia;
  • Osmotic fragility of red blood cells;
  • Persistent erythrocyte agglutination;
  • Primary and secondary immune-mediated hemolysis
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.