Immune-mediated hemolytic anemia in a German Shepherd : diagnosis and successful long-term treatment

Abstract

"Darby," a three year old female spayed German Shepherd, presented to the Cornell University Hospital for Animals (CUHA) with previously diagnosed immune-mediated hemolytic anemia (IMHA) that had been treated with dexamethasone and penicillin. Initial evaluation of Darby at the referring veterinarian's hospital disclosed lethargy, anorexia, brown-tinged urine, fever, splenomegaly, and icteric, pale mucous membranes. Despite increasing doses of dexamethasone and a blood transfusion, Darby's anemia and clinical condition worsened over the one week period of management. At CUHA, in addition to previously noted clinical signs, Darby had muscle wasting, skin fragility, gastrointestinal hemorrhage, urinary tract infection, and propensity to bleeding and clot formation. These changes were attributable to complications of IMHA and corticosteroid therapy. A specific cause of IMHA was never detected. During two weeks of hospitalization, Darby slowly improved with red blood cell and plasma transfusions, expanded immunosuppressive therapy, antibiotics, anti-emetics, an anti-thrombotic agent, gastroprotectant medications, nasal oxygen, and extensive nursing care. Seven months after hospital discharge, Darby remains healthy with a PCV of 45%, and continues to be slowly tapered off medications.