A 4 year old female spayed Golden Retriever dog was presented with acute collapse following a 2 day history of lethargy and hematochezia. On presentation, the patient was dyspneic with severely icteric and pale mucous membranes and sclera. Point-of-care blood work revealed a severe anemia with spherocytes and icteric plasma. A saline slide agglutination test was positive for macroaggluti-nation. The dog was given a transfusion of packed red blood cells (RBCs) and subsequently devel-oped central vestibular disease with vestibular ataxia and nystagmus.

A complete blood count revealed a severe non-regenerative anemia with marked spherocytosis and ghost cells, an inflammatory leukogram (neutrophilia with a left shift and toxic change and a mono-cytosis) and moderate thrombocytopenia. A biochemistry panel revealed evidence of hypovolemia and hypoxic injury, as a consequence of the immune-mediated hemolytic anemia (IMHA). Coagu-lation testing revealed evidence of hypercoagulability. Tests for infectious diseases (Babesia PCR, 4DX Snap test) were negative and zinc concentrations were low. Abdominal ultrasonographic and thoracic radiographic examination revealed no underlying cause for the anemia. Due to the lack of an appropriate regenerative response to the patient’s anemia, a bone marrow aspirate was per-formed, which revealed marked erythroid hypoplasia, with <5% erythroid precursors. The dog was diagnosed with pure red cell aplasia (PRCA) with a concurrent peripheral IMHA.

The dog was treated aggressively with multiple transfusions of packed RBCs, immunosuppressive medications, antithrombotic drugs, anti-nausea and gastroprotectant medications, and an antibiotic. Over the following months, the patient’s hematocrit steadily increased and the immune-mediated anemia entered remission.